Abstract:

BACKGROUND:There is limited evidence on the long-term efficacy of transanal hemorrhoidal dearterialization compared with hemorrhoidectomy. Most studies investigated short-term effects with postoperative pain as the primary outcome. Being a benign disease the long-term goal of treatment for hemorrhoids is the resolution of symptoms and improvement of quality of life. OBJECTIVE:To compare the effect of minimal open hemorrhoidectomy versus transanal hemorrhoidal dearterialization on patient-reported symptoms. DESIGN:Open-label randomized controlled trial. SETTINGS:Single-center study. PATIENTS:Patients with symptomatic hemorrhoids grade II-IV (Goligher's classification). INTERVENTIONS:Patients were randomly allocated to minimal open hemorrhoidectomy or transanal hemorrhoidal dearterialization. MAIN OUTCOME MEASURES:Primary outcome was symptoms assessed by the Hemorrhoidal Disease Symptom Score one year postoperatively. Secondary outcomes included health-related quality of life, patient satisfaction, postoperative pain and recovery, adverse events, recurrence and hospital costs. RESULTS:Forty-eight patients received minimal open hemorrhoidectomy and fifty patients received transanal hemorrhoidal dearterialization. No difference in symptom score at one-year follow-up was found. Median (range) symptom score was 3 (0-17) after Minimal Open Hemorrhoidectomy and 5 (0-17) after transanal hemorrhoidal dearterialization (median difference [CI95%]: -1.0 [-3.0-0.0], p=0.15). Residual hemorrhoidal prolapse was reported more frequently (p=0.008) and more patients had treatment for recurrence after transanal hemorrhoidal dearterialization (7 vs. 0 patients, p=0.013). Patient satisfaction was higher after minimal open hemorrhoidectomy (p=0.049). No differences were found in the impact on health-related quality of life, average and peak postoperative pain, recovery, or adverse events (p>0.05). Transanal hemorrhoidal dearterialization was more expensive (median difference [CI95%]: &OV0556; 555 [472-693], p