A comparison of surgical devices for grade II and III hemorrhoidal disease. Results from the LigaLongo Trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy

TitreA comparison of surgical devices for grade II and III hemorrhoidal disease. Results from the LigaLongo Trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy
Type de publicationArticle de revue
AuteurVenara, Aurélien , Podevin, Juliette, Godeberge, Philippe, Redon, Yann, Barussaud, Marie-Line, Sielezneff, Igor, Queralto, Michel, Bourbao, Cecile, Chiffoleau, Anne, Lehur, Paul-Antoine
OrganismeLigaLongo Study Group
EditeurSpringer Verlag
TypeArticle scientifique dans une revue à comité de lecture
Année2018
LangueAnglais
DateOctobre 2018
Numéro10
Pagination1479-1483
Volume33
Titre de la revueInternational journal of colorectal disease
ISSN1432-1262
Mots-clésAdult, Arteries, Digestive System Surgical Procedures, Hemorrhoids, Humans, Ligation, Rectum, Sutures, Treatment Outcome
Résumé en anglais

PURPOSE: Little is presently known on the impact of device type for Doppler-guided hemorrhoidal artery ligation/mucopexy (DGHAL) or circular stapled hemorrhoidopexy (CSH) when a surgical treatment is considered for hemorrhoidal disease (HD). In this study, we aimed to compare the outcome in terms of adverse events and recurrence rate, of patients included in the multicenter LigaLongo RCT ( ClinicalTrials.gov NCT01240772) according to the type of devices used.

METHODS: In the DGHAL arm (N = 193), the procedure was done with transanal hemorrhoidal dearterialization (THD)™ (THD, Correggio, Italy) (104 patients) and with HAL-RAR™ (Agency for Medical Innovations (AMI) GmbH, Feldkirch, Austria) (89 patients). In the CSH arm (N = 184), procedure for prolapse and hemorrhoids (PPH)-03™ (Ethicon Endo-Surgery, Cincinnati OH) and hemorrhoidopexy and prolapse (HEM)™ (Covidien, Inc.) staplers were used in respectively 106 and 78 cases. Surgery-related morbidity at 90 postoperative days (POD) based on the Clavien-Dindo procedure-related complication score and clinical outcome in terms of recurrence and reoperation rate at 12 postoperative months (POM) was collected.

RESULTS: Three hundred and seventy-seven patients were randomized according to HD grade. In the DGHAL arm, the number of ligations and mucopexies was higher in the AMI group (p < 0.0001); at 90 POD, the overall morbidity was similar between the two groups. In the CSH arm, donut sizes were similar; at 90 POD, the PPH group had a higher risk of postoperative grade 1 morbidity (anal urgency or incontinence) compared to the HEM group (p = 0.003). At 12 POM, no statistical difference was found between the two groups of each arm in terms of grade III recurrence or reoperation.

CONCLUSION: Postoperative morbidity and outcome at 1 year were similar regardless of the type of devices used. These findings suggest that device type has little impact on HD treatment results.

TRIAL REGISTRATION: clinicaltrials.gov -Identifier NCT01240772.

URL de la noticehttp://okina.univ-angers.fr/publications/ua18694
DOI10.1007/s00384-018-3093-8
Lien vers le document

https://link.springer.com/article/10.1007%2Fs00384-018-3093-8

Titre abrégéInt J Colorectal Dis
Identifiant (ID) PubMed29808305