title: Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids.
abstract: OBJECTIVE
  Doppler-guided transanal haemorrhoid dearterialization (THD) and stapler haemorrhoidopexy (SH) have been demonstrated to be less painful than the Milligan-Morgan procedure. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of third-degree haemorrhoids in an equivalent trial.
  
  
  METHODS
  One hundred and sixty-nine patients with third-degree haemorrhoids were randomized online to receive THD (n = 85) or SH (n = 84) in 10 Colorectal Units in which the staff were well trained in both techniques. The mean follow-up period was 17 (range 15-20) months.
  
  
  RESULTS
  Early minor postoperative complications occurred in 30.6% of patients in the THD group and in 32.1% of patients in the SH group. Milder spontaneous pain and pain on defecation were reported in the THD group in the first postoperative week, but this was not statistically significant. Late complications were significantly higher (P = 0.028) in the SH group. Residual haemorrhoids persisted in 12 patients in the THD group and in six patients in the SH group (P = 0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P = 0.34). No differences were found in postoperative incontinence. The obstructed defecation score (ODS) was significantly higher in the SH group (P < 0.02). Improvement in quality of life was similar in both groups. Postoperative in-hospital stay was 1.14 days in the THD group and 1.31 days in the SH group (P = 0.03).
  
  
  CONCLUSIONS
  Both THD and SH techniques are effective for the treatment of third-degree haemorrhoids in the medium term. THD has a better cost-effective ratio and lower (not significant) pain compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.
authors.affiliation: Department of Surgery, S. Maria dei Battuti Hospital, S. Vito al Tagliamento, PN, Italy. aldo.infantino@mac.com
authors.forename: A
authors.initials: A
authors.lastname: Infantino
authors.forename: D F
authors.initials: DF
authors.lastname: Altomare
authors.forename: C
authors.initials: C
authors.lastname: Bottini
authors.forename: M
authors.initials: M
authors.lastname: Bonanno
authors.forename: S
authors.initials: S
authors.lastname: Mancini
authors.forename: T
authors.initials: T
authors.lastname: Yalti
authors.forename: P
authors.initials: P
authors.lastname: Giamundo
authors.forename: J
authors.initials: J
authors.lastname: Hoch
authors.forename: A
authors.initials: A
authors.lastname: El Gaddal
authors.forename: C
authors.initials: C
authors.lastname: Pagano
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000098:blood supply / Q000000981:diagnostic imaging / Q000601:surgery*; D003672:Defecation; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D057194:Intention to Treat Analysis; D007902:Length of Stay; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D019106:Postoperative Hemorrhage / Q000209:etiology; D011788:Quality of Life; D012008:Recurrence; D017792:Surgical Stapling / Q000009:adverse effects; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult