title: Transanal anopexy with HemorPex System (HPS) is effective in treating grade II and III hemorrhoids: medium-term follow-up.
abstract: BACKGROUND
  Hemorrhoidal disease is a common proctologic disorder. The HemorPex System(®) (HPS) (Angiologica, S. Martino Siccomario PV, Italy) is an innovative surgical technique based on muco-hemorrhoidopexy without Doppler guidance. The aim of this study was to evaluate the efficacy of HPS in on the treatment of grade II and III hemorrhoids.
  
  
  METHODS
  One hundred patients with grade II and III hemorrhoidal disease were included in the study and operated on using HPS without Doppler guidance. The procedure consists of a mucopexy carried out by means of a dedicated rotating anoscope in the 6 relatively constant positions of the terminal branches of the superior hemorrhoidal artery. A direct follow-up was carried out on 100 patients for up to 3 months. A late analysis (>12 months postoperatively) was conducted by telephone interview. At follow-up the following parameters were considered: pain, bleeding, prolapse, difficulties with hygiene and patient satisfaction with treatment.
  
  
  RESULTS
  Operative time was 16 ± 5 min. Three-month follow-up showed significant improvement of symptoms: pain was present in 10 (10 %) patients versus 45 (45 %) preoperatively; bleeding in 13 (13 %) of patients versus 57 (57 %) preoperatively; prolapse in 13 (13 %) of patients versus 45 (45 %) preoperatively and difficulties with hygiene in 1 (1 %) versus 24 (24 %) preoperatively (all p < 0.05). At longer follow-up which was available in 67 patients, 5 patients (7.5 %) had recurrence and were reoperated on at 8, 10, 24, 26 and 36 months, respectively after the first procedure. As regards patient satisfaction, complete satisfaction was reported by 95/100 patients (95 %) at 3 months, 62/67 (92.5 %) at 12 months and 8/56 (85.7 %) at 24 months; partial satisfaction was reported by 3/100 patients (3 %) with intermittent bleeding at 3 months, 3/67 (4.4 %) patients at 12 months and 6/56 (10.7 %) patients at 24 months, all with either intermittent bleeding or prolapse. Dissatisfaction with the procedure was reported by in 1/100 (1 %) patient at 3 months, 2/67 (2.9 %) at 12 months and 2/56 (3.6 %) at 24 months including patients who underwent reintervention.
  
  
  CONCLUSIONS
  HPS can be used in the treatment of grade II and III hemorrhoidal disease. Our results show that this simple technique may be an effective but due to the important limitations of this study (loss to follow-up, non-comparative study) further studies are required.
authors.affiliation: Department of General Surgery, "Spirito Santo" General Hospital, Via Fonte Romana, 65124, Pescara, Italy. dr.mbasile@gmail.com.
authors.forename: M
authors.initials: M
authors.lastname: Basile
authors.affiliation: Department of Experimental and Clinical Science, "G. D'Annunzio" University, Chieti, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Di Resta
authors.affiliation: Department of Experimental and Clinical Science, "G. D'Annunzio" University, Chieti, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Ranieri
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery*; D013505:Digestive System Surgical Procedures / Q000295:instrumentation* / Q000379:methods / Q000523:psychology; D004867:Equipment Design; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000473:pathology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation* / Q000379:methods / Q000523:psychology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology / Q000209:etiology; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011184:Postoperative Period; D012005:Rectal Prolapse / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Doppler; HemorPex System (HPS); Hemorrhoids; Muco-hemorrhoidopexy