Treatment of grade III and IV haemorrhoidal disease  with PPH or THD. A randomized trial on postoperative  complications and short-term results.
OBJECTIVE
Haemorrhoidal disease is a frequently occurring entity in the western world. The Procedure for prolapse and haemorrhoids (PPH) and transanal haemorrhoidal dearterialisation (THD) are the most important surgical treatments that respect normal anal anatomy. This is the first randomized trial that compares both techniques in the treatment of grade III and IV haemorrhoids.


METHODS
Patients with grade III or IV haemorrhoids were randomized between PPH and THD. Patients were seen after 1 week, 3 weeks and 6 weeks postoperatively. Primary endpoint was resolved symptoms 6 weeks postoperatively. Secondary endpoints were pain, measured with a visual analogue scale (VAS) after 1 day, 1 week and 3 weeks, and complications.


RESULTS
Eighteen patients were allocated to PPH versus 23 to THD. Success rates after 6 weeks were 83% in the PPH group versus 78% in the THD group. VAS scores were significantly lower after 1 day and 1 week in the THD group, but equalled out after 3 weeks. Twelve percent of the patients after PPH and 4% after THD needed an urgent readmission to treat an acute bleeding. Overall complication rates did not differ significantly.


CONCLUSIONS
Both PPH and THD are safe treatments for grade III and IV haemorrhoids with acceptable complication rates and good short-term results. THD might be the preferred treatment because it carries the similar complication rate and short-term results, but results in less postoperative pain when compared with PPH. Moreover, it is a less invasive, more easily learned and less costly procedure.
Departement of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands. sebastiaanfesten@yahoo.com
Sebastiaan
S
Festen
M J
MJ
van Hoogstraten
A A W
AA
van Geloven
M F
MF
Gerhards
D000328:Adult; D013505:Digestive System Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications / Q000209:etiology*; D013997:Time Factors