Prospective randomised multicenter study comparing Stapler Haemorrhoidopexy (SH) with Doppler guided Transanal Haemorrhoid Dearterialization (THD) for III degree haemorrhoids

Infantino A., Altomare D. F., Bottini C., Bonanno M., Mancini S. and the THD group of the SICCR (Italian Society of Colorectal Surgery)
Colorectal Disease. Article accepted on 17th January 2011

Doppler guided Transanal Haemorrhoid Dearterialization (THD) and Stapler Haemorrhoidopexy (SH) have been demonstrated to be less painful than Milligan-Morgan. The aim of this study was to compare the effectiveness of THD vs SH in the treatment of III degree haemorrhoids in an equivalent trial.

169 patients with III degree haemorrhoids were randomised on-line to receive THD (85) or SH (84) in 10 colorectal units well-trained in both techniques. The mean follow up period was 17 months (range 15-20 months).

Early minor postoperative complications occurred in 30.6% in the THD group and 32.1% in the SH group. There was a less intensive pain in THD group in the first postoperative week for spontaneous pain and pain on defecation but this was not statistically significant. Late complications were significantly higher (P=0.028) in the SH group. In THD and SH group residual haemorrhoids persisted in 12 and 6 patients (P=0.14). Six patients in the SH group and 10 in the THD group underwent further treatment of haemorrhoids (P=0.34). No differences were found in postoperative incontinence. The ODS score was significantly higher in the SH group (p<0.02). QoL improved in both groups equally. Postoperative in hospital stay was 1,14 in THD and 1,31 days in SH group (p=0.03).

Both techniques are effective for III degree haemorrhoids in the medium term. THD has a better cost/effective ratio and low (not significant) compared with SH. Postoperative pain and recurrence did not differ significantly between the two groups.