Outcome of stapled hemorrhoidopexy versus doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids

Purpose. The aim of the study was to evaluate the long-term results, early and late complication rates and overall satisfaction of patients with grade III hemorrhoids treated by stapled hemorrhoidopexy (SH) or doppler-guided hemorrhoidal artery ligation (DGHAL). Methods. Operative and follow-up patient data were prospectively collected for patients undergoing either SH or DGHAL by a single surgeon during a 2-year period. A retrospective comparison between patient outcomes after operations by one of the two methods was made based on these data. Clinical data on postoperative pain, analgesic requirements, time to first bowel movement and functional recovery were collected at five postoperative follow-up visits (1 and 6 weeks, 6, 12, and 18 months). Data on patient satisfaction, recurrence of hemorrhoidal symptoms and further treatment were obtained from a standardized questionnaire completed during the last visit 18 months postoperatively. Results. A total of 63 patients underwent SH (average age 52 +/- 3.2 years) and 51 patients underwent DGHAL (average age 50 +/- 7.3 years). The DGHAL patients experienced less postoperative pain as scored by pain during bowel movement (2.1 +/- 1.4 vs. 5.5 +/- 1.9 for SH), and required less postoperative analgesics. Hospital stay, time to first bowel movement and complete functional recovery were also significantly shorter for the DGHAL patients. A total of 9 DGHAL patients (18%) suffered from persistent bleeding or prolapse and required additional treatment compared with 2 (3%) patients in the SH group. The SH patients reported greater satisfaction compared with DGHAL patients at 1 year postoperatively. Conclusions. Both SH and DGHAL are safe procedures and have similar effectiveness for treating grade III hemorrhoid;s however DGHAL is less painful and provides earlier functional recovery but is associated with higher recurrence rates and lower satisfaction rates compared with SH.