title: A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids.
abstract: BACKGROUND
  Doppler guidance in hemorrhoidal surgery has become more frequent during the past decade. The method is mainly studied in nonrandomized trials. Data from randomized controlled trials are lacking.
  
  
  OBJECTIVE
  The aim of this study was to compare early and midterm results of transanal hemorrhoidal dearterialization with anopexy to open hemorrhoidectomy. DESIGN, SETTINGS, PATIENTS, AND INTERVENTIONS: Forty patients with grade 2 to 3 hemorrhoids were randomly assigned to transanal hemorrhoidal dearterialization with anopexy (group A, n = 20) or open hemorrhoidectomy (group B, n = 20). A diary was used during the first 2 postoperative weeks. A self-reported symptom questionnaire was answered, and a clinical examination was performed preoperatively, after 2 to 4 months, and after 1 year.
  
  
  METHODS
  The main outcome measure was postoperative pain.
  
  
  RESULTS
  Postoperative peak pain was lower in group A during the first week than in group B (p < 0.05), whereas no difference in overall pain was noted. More patients expressed normal well-being in group A (p = 0.045). Pain, bleeding, and the need for manual reduction of the hemorrhoids were all improved in both groups after 1 year (p < 0.05). Soiling had decreased after both methods at early follow-up. After 1 year, soiling was significantly decreased only after open hemorrhoidectomy. The grade of hemorrhoids was significantly reduced after 1 year for both methods, but there was a trend to more patients with remaining grade 2 hemorrhoids in group A (p = 0.06).
  
  
  CONCLUSIONS
  There was no blinding, the sample size was small, and follow-up was for only 1 year. The questionnaire was not validated.
  
  
  CONCLUSIONS
  The difference in postoperative pain between transanal hemorrhoidal dearterialization with anopexy and open hemorrhoidectomy may be less than expected based on previous literature.
authors.affiliation: Department of Surgery, Ersta Hospital, Institute of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. solveig.elmer@erstadiakoni.se
authors.forename: Solveig E
authors.initials: SE
authors.lastname: Elmér
authors.forename: Jonas O
authors.initials: JO
authors.lastname: Nygren
authors.forename: Claes E
authors.initials: CE
authors.lastname: Lenander
mesh_terms: D000556:Ambulatory Surgical Procedures; D001003:Anal Canal / Q000098:blood supply* / Q000601:surgery*; D001158:Arteries / Q000601:surgery; D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000145:classification / Q000601:surgery*; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010149:Postoperative Pain; D011183:Postoperative Complications; D062707:Return to Work