Long-term results of desarterization and mucopexy in the treatment of hemorrhoids of stage II-III

Aim. To evaluate long-term results of haemorrhoidal artery ligation with mucopexy by digital examination to compare with traditional HAL-RAR procedure in surgical treatment haemorrhoidal disease (HD) II-III stage.

Material and Methods. The controlled randomized trial included 150 patients with II-III stage of HD: patients in the  study group (n=75) were operated using digital palpation  with mucopexy, in the control group we used HAL-RAR technique. The primary endpoint was recurrence of main symptoms. Secondary endpoints: patient satisfaction and discomfort, pain intensity, prolapse of haemorrhoidal piles and rectal bleeding.

Results.The groups did not differ in  gender, age, body mass index, stage and symptoms of haemorrhoidal disease. During 12 month follow-up there are no difference in prolapse of haemorrhoidal piles (p=0,49), patient satisfaction (p=0,95), discomfort (p=0,67). Complaint of periodic bleeding in the groups : 5,3% and 17,3%, respectively (р=0,037). Recurrence developed: the study group- 8(10,6%), the control group- 22(29,3%), respectively( p=0,037). During 18 month follow-up the groups did not differ in patients satisfaction (p=0,95), discomfort(p=0,89), but the rate of haemorrhoidal prolapse was significantly higher  in first group,16,3%, and 13,5% in the second group (p=0,045); bleeding 10,2% and 15,4%, respectively( p=0,86).  Open hemorrhoidectomy was performed 2 (2,6%) in the study group and 4(5,3%) patients in the control group (p=0,86) as a result of relapse of haemorrhoidal prolapse.

Conclusion. Ligation of HA with combination of mucopexy  without ultrasound guidance is safety, easy reproducible technique, comparable   in effectiveness  of HAL-RAR in long-term results. This procedure can be recommended  for surgical treatment of hemorrhoids II-III stage.