SNFGE SNFGE
 
Thématique :
- Coloproctologie
Originalité :
Intermédiaire
Solidité :
Intermédiaire
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Docteur Vincent DE PARADES
Coup de coeur :
 
 
Techniques in Coloproctology
  2017/08  
 
  2017 Aug;21(8):657-665.  
  doi: 10.1007/s10151-017-1673-1  
 
  A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids.  
 
  Tsunoda A, Takahashi T, Kusanagi H  
  https://www.ncbi.nlm.nih.gov/pubmed/28871428  
 
 

Abstract

BACKGROUND:

The aim of the present study was to compare short- and medium-term results of transanal Doppler-guided hemorrhoidal dearterialization with mucopexy (DM) versus hemorrhoidectomy using an ultrasonic scalpel (US) for third-degree hemorrhoids.

METHODS:

Forty-four patients were randomly assigned to undergo either DM or US. The patients were followed up at 1, 2, 3 months at our clinic, and by telephone interview when the study was completed in May 2017. The primary endpoint was postoperative pain with quality of life, length of stay, return to normal activities, and incontinence among secondary endpoints.

RESULTS:

Postoperative pain was less intense in the DM group than in the US group during week 1 (p < 0.05), but no difference was seen after 2 weeks. More DM patients returned to normal daily activities within 3 days (p < 0.05). There were no between-group differences in quality of life. One patient in each group developed postoperative hemorrhage requiring readmission. No differences were found between the groups in postoperative incontinence, obstructed defecation scores, or SF-36. During a median 33-month follow-up (range 12-46 months), two patients in the DM group and one patient in the US group underwent further surgery for residual hemorrhoid related problems. Two patients in the DM group required further rubber band ligation.

CONCLUSIONS:

Medium-term results demonstrated that DM and US have similar effects on quality of life in the treatment of third-degree hemorrhoids. However, DM was associated with less early postoperative pain than US and a faster return to normal activities.

 
  
Question posée
 
Comparaison de la technique des ligatures sous contrôle doppler avec mucopexie à l’hémorroïdectomie au bistouri à ultrasons chez des patients ayant un prolapsus hémorroïdaire de grade 3 de Goligher.
  
Question posée
 
Moins de douleurs et reprise plus rapide de l’activité après la technique des ligatures sous contrôle doppler avec mucopexie et une efficacité similaire sur les symptômes hémorroïdaires après 33 mois de suivi médian.
  
Commentaires

Un essai contrôlé randomisé critiquable pour diverses raisons (effectifs faibles, variantes techniques, suivi court) mais qui démontre quand même encore, s’il en était besoin, l’excellente tolérance postopératoire de la technique des ligatures sous contrôle doppler avec mucopexie et sa bonne efficacité à moyen terme.
 
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