DIGITALLY GUIDED TRANSANAL SELECTIVE HEMORRHOIDAL DEARTERIALIZATION WITH MUCOPEXY VERSUS MILLIGAN MORGAN HEMORRHOIDECTOMY FOR TREATMENT OF HEMORRHOIDS– EARLY AND LONG-TERM POSTOPERATIVE RESULTS

Abstract

Background:- Transanal Hemorrhoidal Dearterialization(THD) with Mucopexy is
one of the most popular and actively studied surgical procedure for stage II-IV
Hemorrhoidal disease. Studies have already established equivalent results even
without use of doppler.
Aim:-To analyse prospectively, results of Digitally-guided selective THD-Mucopexy
versus Conventional Hemorrhoidectomy with regard to early and long-term
postoperative results, Efficacy of Digitally-guided THD in absence of doppler for
hemorrhoidal artery ligation and to measure the Quality of life and patients’
satisfaction after both procedures after one year followup.
Methods: This is a single-center prospective randomized interventional study. 100
patients with Grade II-IV hemorrhoids were selected and randomly divided into two
equal groups of 50 each. Pre operative examination, including proctoscopy, baseline
questionnaire scoring with Giordano and Vaizey incontinence score was done. THDMucopexy was performed in one group and Milligan-Morgan Hemorrhoidectomy in
another group. A visual analog scale (VAS) was used to measure pain. Post
operatively Giordano questionnaire and Vaizey score were reassessed. Clavien Dindo
grading was used to grade postoperative complications. Patients, were discharged on
2
nd postoperative day when adequate pain control, oral tolerance and spontaneous
micturition were achieved. Telephonic conversation done on day 3 and further Outpatient follow up on day 7th and 30th postoperative day and thereafter at 3,6,12
months.
Results:- The two groups were similar regarding the stage of the disease and the
basic patients’ demographics. Postoperative mean VAS score for pain was
significantly lower with minimal requirement of Mean total number of rescue
analgesia (inj diclofenac 75mg-1 unit) 0.72±0.775 in the THD-M group as
compared to MM group with mean score of 1.98±1.048 (p value-<0.001). We also
found that the mean Vaizey score for anal incontinence for gas was higher among the
MM group 1.26±1.09 as compared to 0.34±0.71 (p value<0.001) in the THD-M
group. Prolapse (including Grade III and IV hemorrhoids) rates were higher in the
THD-M group 8(16%) out of 50 cases, as compared to 4 (8%) out of 50 cases,but
without any statistical difference. Recurrence of hemorrhoids including both prolapse
and bleeding was found to be 12 cases (24%) out of 50 cases in both groups,showing
no statistical significance. Mean satisfaction score was found to be higher in the
THD-M group 3.94±1.405 as compared to 3.36±1.424 (p value-0.045).
Conclusion:- Transanal hemorrhoidal Dearterialization with mucopexy had fewer
complications, comparative recurrence rate, and higher patient satisfaction than
Milligan Morgan Hemorrhoidectomy even without a Doppler device. Therefore,
THD-M appears to be a safe and satisfactory surgical procedure in the treatment of
grade II-IV hemorrhoids. However incidence of prolapse was slightly higher in the
THD-Mucopexy group in comparison with grade IV hemorrhoids.