Impact of Mucopexy during Trans-Anal Haemorrhoidal Dearterialization on Post-operative pain and Recurrence in Hemorrhoidal Disease

Published Date: 15th September 2021

Publication Authors: Kearsey C, Javed M, Rajaganeshan R

Background
Single center experience of trans-anal haemorrhoidal dearterialization (THD) with and without mucopexy; evaluating differences in recurrence, pain and post-operative complications

Method
Retrospective analysis of all patients undergoing THD between October 2014-September 2016, with and without mucopexy procedure depending on clinical need. Primary outcome was symptom recurrence; this was evaluated during clinic follow up and subsequent re-presentation to healthcare services.

Results
A total of 495 patients were available for analysis and 191 (38.5%) had mucopexy at the time of THD. All patients undergoing mucopexy had a statistically significant increase in recurrence, pain and post-operative complications (P < 0.001). 38% who underwent mucopexy had complications compared to 1.4% who did not have mucopexy (P = 0.001). A subgroup analysis of the 159 (32%) treatment naïve patients, 85% had pain after mucopexy (P = 0.556) and 17% had recurrence of symptoms compared to 1.5% without mucopexy (P = 0.004). Mucopexy significantly increases complication rates in grade both grade III-IV (OR:509.97 CI:19.45–13371.19 P = 0.000) with grade 3 having less complications than grade 4. (OR:0.210 CI:0.097–0.453 P = 0.000) Number of mucopexy plications increased the rate of recurrence (OR:2.322 CI:1.263–4.269 P = 0.007) thought to be due to recurrence primary symptoms (i.e. bleeding or prolapse).

Conclusion
Our data shows that mucopexy used with THD can result in significant pain, recurrence and complications. We propose a two-stage procedure depending upon the patient’s initial complaint. Stage one THD, followed by clinical assessment of the patient. If asymptomatic at follow up, a second stage mucopexy can be considered.

 

Kearsey, C; Javed, MA; Rajaganeshan, R et al. (2021). Impact of Mucopexy during Trans-Anal Haemorrhoidal Dearterialization on Post-operative pain and Recurrence in Hemorrhoidal Disease – Should THD be a two-stage procedure?. Colorectal Disease. 23 (Suppl 1), 117

 

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