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Transanal Hemorrhoidal Dearterialization vs Ferguson Hemorrhoidectomy in the Treatment of Hemorrhoidal Disease
Vito M. Stolfi1, Ilaria Capuano*1, Chiara Micossi2, Felice Nigro2, Pierpaolo Sileri1
1General Surgery, Tor Vergata University, Rome, Rome, Italy; 2Villa Tiberia Hospital, Rome, Italy

Introduction:
Transanal hemhorrhoidal dearterialization (THD) consists in the doppler-guided ligation of terminal branches of superior rectal arteries (dearterialization) which reduces the arterial overflow to the hemorrhoidal piles, and in the suture plication of the redundant rectal mucosa/submucosa (called mucopexy), that is able to re-locate the prolapsed tissue to its anatomical site.
Patients and methods:
Since 2012 we prospectively collected information about 122 Ferguson and 82 THD procedures. As for Ferguson hemorrhoidectomy M:F ratio was 73/49 and mean age was 48,19+/-14,17. One (1%) had II degree hemorrhoids, 35 (29%) had III degree and 85 (70%) had IV degree. Mean follow up was 16,66+/-20,55 months. THD patients were 38 males and 44 females. Their mean age was 50,83+/-12,4 and 2 of them (3%) had II degree hemorrhoids, 32 (39%) had III degree, and 48 (58%) had IV degree. Mean follow up for the THD group was 12,97+/-10,18 months. Statistical analysis was performed using GraphPad Prism 4.0 (t-student test for continuous variables and Chi-square test for categorical variables).
Results:
There were no statistically significant differences between patients treated with Ferguson and THD techniques, in terms of duration of pain, pain intensity during the first 8 PO days, measured by VAS scale, soiling, post-operative bleeding, tenesmus, prurigo, return to work, satisfaction rate. Early complications rate (<30 days) is low for both techniques (12% for Ferguson and 16% for THD), with no significant differences. Regarding late complications (>30 days), we found out that urgency and recurrence of symptoms occurred more often in patient treated with THD (p=0,001 and 0,007, respectively).
Conclusions:
THD is a safe and effective procedure, which allows a quick return to daily activities, although it seems to be associated with a higher risk of recurrence and urgency.
The low rate of complications makes it a safe procedure for high ASA score and fragile patients.


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