Long-term results of dearterialization and mucopexy for stage II–III hemorrhoids

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Abstract

BACKGROUND: Nowadays, minimally invasive procedures are mainly performed in the treatment of hemorrhoidal diseases. However, the feasibility of using ultrasound navigation for hemorrhoidal artery ligation-rectoanal repair (HAL-RAR) is still discussed because digital palpation of hemorrhoidal arteries for ligation is safe and easy to perform.

AIM: To evaluate the long-term results of HAL with mucopexy by digital examination in comparison with traditional HAL-RAR in the surgical treatment stage II–III hemorrhoidal disease.

MATERIALS AND METHODS: The controlled randomized trial included 150 patients with stage II–III hemorrhoidal disease. The study group (n=75) included patients who underwent surgery using digital palpation with mucopexy, and in the control group (n=75), the HAL-RAR was used. The primary endpoint was a recurrence of the main symptoms. Secondary endpoints included patient satisfaction and discomfort, pain intensity, prolapse of hemorrhoidal piles, and rectal bleeding.

RESULTS: The groups did not differ in sex, age, body mass index, and stage, and symptoms of hemorrhoidal disease. During the 12-month follow-up, no difference in the prolapse of hemorrhoidal piles (p=0.49), patient satisfaction (p=0.95), and discomfort (p=0.67) was found. Periodic bleeding occurred in 5.3% and 17.3% of the patients in the study and control groups, respectively (p=0.037). After 2 months of follow-up, pain recurred in 8 (10.6%) patients in the study group and 22 (29.3%) in the control group (p=0.037). At 18 months follow-up, no difference in patient satisfaction (p=0.95) and discomfort (p=0.89) was noted; however, the rate of hemorrhoidal prolapse was significantly higher in the study group (16.3%) than in the control group (13.5%) (p=0.045), and bleeding was reported in 10.2% and 15.4% of the patients in these groups, respectively (p=0.86). Open hemorrhoidectomy for relapse of hemorrhoidal prolapse was performed in 2 (2.6%) patients in the study group and 4 (5.3%) patients in the control group (p=0.68).

CONCLUSION: Ligation of hemorrhoidal arteries in combination with mucopexy without ultrasound guidance is a safe, easy, and reproducible technique, with comparable effectiveness, and long-term results to HAL-RAR. This procedure can be recommended for the surgical treatment of stage II–III hemorrhoids.

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About the authors

Maxim A. Popovtsev

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: maksim_popovcev@mail.ru
ORCID iD: 0000-0002-1566-1528

graduate student

Russian Federation, 2/4 B. Pirogovskaja street, 119991 Moscow

Darya D. Shlyk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: shlikdarya@gmail.com
ORCID iD: 0000-0002-9232-6520
SPIN-code: 4948-3550

MD, Cand. Sci. (Med.), associate professor

Russian Federation, 2/4 B. Pirogovskaja street, 119991 Moscow

Aftandil V. Alekberzade

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: aftandil.v.alekberzade@gmail.com
ORCID iD: 0000-0002-2895-8478
SPIN-code: 7142-3846

MD, Dr. Sci. (Med.), professor

Russian Federation, 2/4 B. Pirogovskaja street, 119991 Moscow

Petr V. Tsarkov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: tsarkov@kkmx.ru
ORCID iD: 0000-0002-7134-6821
SPIN-code: 7570-0664

MD, Dr. Sci. (Med.), professor

Russian Federation, 2/4 B. Pirogovskaja street, 119991 Moscow

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