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A Critical Appraisal on Different Techniques to Treat Haemorrhoids. Results From a Large Prospective Study
Mostafa Shalaby*1,2, Giovanni Milito 1, Vito M. Stolfi3, Claudio Toscana3, Ilaria Capuano1, Gabriella Giarratano3, Luana Franceschilli1, Giulia Missori1, Silvia Quaresima1, Pierpaolo Sileri1
1Surgery, University of Rome Tor Vergata, Rome, Italy; 2Surgery, Mansoura University, Mansoura, Egypt; 3Villa Tiberia Hospital, Rome, Italy
Background: Many procedures have been described for the treatment of Haemorrhoids with no method is considered superior. Complications still important factors in comparing these different procedures. In this study we report complications after haemorrhoidal surgery in a large volume academic institution as recommended strategies for prevention and management.
Patients and Methods: Data on subjects who underwent Milligan-Morgan (MM), Ferguson's haemorrhoidectomy, radiofrequency (RF), stapled haemorroidopexy (SH), and trans-arterial haemorrhoidal dearterialization (THD) for grade III, IV haemorrhoid between January 2000 and May 2015 were prospectively collected and analyzed. Recorded data were demographics, type of surgery and short as well as longer-term results.
Results: A total of 2751 were considered: 282 (MM), 271 (Ferguson), 1171 (RF), 878 (SH), and 149 (THD). MM causes the highest VAS score, with 30% of patients complaining about VAS>7, while SH seems to be the less painful technique, with only 7.5% of patients with VAS>7. Otherwise, SH causes the highest rate of haemorrhage, which occurred in 4.8% of patients, followed by RF, THD, MM and Ferguson, this one with only 1.8% of post-operative haemorrhage. Also urinary retention is mostly observed in SH patients, with an incidence of 8.2%. As for other complications, such as chronic pain, anal sepsis, and the development of faecal incontinence the results among the various techniques are quite comparable, while a slightly higher risk of developing an anorectal stricture exists with RF. Finally, we observed the highest recurrence rate in patients treated with SH (4.9%), while THD seems to have the lowest one (only 2%).
Conclusions: SH seems to be associated to less pain but a higher risk of recurrence. All other complications seems to be similar among groups, despite a trend toward an increased risk of stricture exists with RF. Good patient’s selection combined to a tailored surgical procedures play a role. Keywords: Haemorrhoids - haemorrhoidectomy - Radiofrequency - Stapled Haemorroidopexy - Trans-arterial Haemorrhoidal Dearterialization
Table 1: Results of 2751 patients
| Our Experience | MM (n=282) | Ferguson (n=271) | RF (n=1171) | SH (n=878) | THD (n=149) | Total (n=2751) | | PO Pain 〉7 on VAS | 86 (30.4%) | 61 (22.5%) | 189 (16%) | 66 (7.5%) | 23 (15%) | 425 (15.4%) | | Chronic Pain | 3 (1%) | 2 (0.7%) | 13 (1.1%) | 19 (2.1%) | 1 (0.6%) | 38 (1.4%) | | Hemorrhage | 7 (2.5%) | 5 (1.8%) | 47 (4%) | 42 (4.8%) | 4 (2.7%) | 105 (3.8%) | | Anal Sepsis | 1 (0.3%) | 3 (1.1%) | 9 (0.7%) | 6 (0.6%) | 0 | 19 (0.7%) | | Anorectal Stricture | 4 (1.4%) | 3 (1.1%) | 24 (2.0%) | 6 (0.6%) | 0 | 27 (1%) | | Incontinence | 4 (1.4%) | 2 (0.7%) | 7 (0.6%) | 0 | 0 | 13 (0.5%) | | Urinary retention | 12 (4.3%) | 16 (5.9%) | 31 (2.6%) | 72 (8.2%) | 5 (3.4%) | 136 (5%) | | Recurrencies | 8 (2.8%) | 7 (2.6%) | 38 (3.2%) | 43 (4.9%) | 3 (2%) | 99 (3.6%) | | | | | | | | | | | | | | | | |
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