Transanal Hemorrhoidal Dearterialization With Mucopexy Versus Ferguson Hemorrhoidectomy for Prolapsed Internal Hemorrhoids

Abstract

Objective: To compare transanal hemorrhoidal dearterialization (THD) with mucopexy to Ferguson hemorrhoidectomy in terms of recurrence rates and quality of life. Background: There is uncertainty regarding the durability of the therapeutic effect of THD with mucopexy compared with Ferguson hemorrhoidectomy in terms of recurrence rates. Methods: This was a multicenter prospective study. Participating surgeons performed the operation they knew best enrolling 10 patients each. Surgeons’ unedited videos were reviewed by an independent expert. Patients with prolapsed internal hemorrhoids in at least 3 columns were eligible. The primary endpoint was recurrence rates defined as prolapsing internal hemorrhoids. Patient-reported outcomes and satisfaction were evaluated with Pain Scale and Brief Pain Inventory, Fecal Incontinence Quality Of Life (FIQOL), Cleveland Clinic Incontinence, Constipation, Short-Form 12 scores, and Patient satisfaction (4-point Likert) scale. Results: Twenty surgeons enrolled 197 patients. THD patients had lower Visual pain scores at postoperative day (POD) 1 (6.2 vs 8.3, P=0.047), POD7 (4.5 vs 7.7, P=0.021), POD14 (2.8 vs 5.3, P<0.001), and medication use at POD14 (23% vs 58%, P<0.001). Median follow-up was 3.1 (1.0–5.5) years. Recurrence rates did not differ between the study arms (5.9% vs 2.4%, P=0.253). Patient satisfaction rate was higher after THD at POD14 (76.4% vs 52.5%, P=0.031) and 3 months (95.1% vs 63.3%, P=0.029), but did not differ at 6 months (91.7% vs 88%, P=0.228) and 1 year (94.2% vs 88%, P=0.836). Conclusion: THD with mucopexy was associated with improved patient-reported outcomes and quality of life as compared with Ferguson hemorrhoidectomy with nonsignificantly different recurrence rates.