Doppler-Guided Transanal Hemorrhoidal Dearterialization (DG-THD) Versus Stapled Hemorrhoidopexy (SH) in the Treatment of Third-Degree Hemorrhoids: Clinical Results at Short and Long-Term Follow-Up.
The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids.



One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average).



At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery.



SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids.
Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy. serglear@tin.it.|Dipartimento Scienze Cliniche Applicate e Biotecnologie, Ospedale Civile San Salvatore, Università degli Studi di L'Aquila, Edificio Delta 6, 67100, L'Aquila, Italy. serglear@tin.it.
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Leardi
Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
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Pessia
Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
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Mascio
Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
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Piccione
Surgery Unit-Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy.
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Schietroma
Department of Life, Health and Environmental Sciences MeSVA, University of L'Aquila, L'Aquila, Italy.
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Pietroletti
D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000098:blood supply / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025321:Surgery, Computer-Assisted; D017792:Surgical Stapling; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
DG-transanal hemorrhoidal dearterialization; Hemorrhoids; Recurrence of hemorrhoids; Stapled hemorrhoidopexy