Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial |
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| Institution: | 1. Center of Interventional Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil;2. Interventional Radiology, Hospital Municipal Vila Santa Catarina Dr Gilson de Cassia Marques de Carvalho, Hospital Israelita Albert Einstein, São Paulo, Brazil;3. Colorectal Department, Hospital Israelita Albert Einstein, São Paulo, Brazil;4. Department of Cardiology, Hospital Israelita Albert Einstein, São Paulo, Brazil;1. Larner College of Medicine at the University of Vermont, University of Vermont, Burlington, Vermont;2. University of Vermont Medical Center, Burlington, Vermont;1. Penn Image-Guided Interventions Laboratory, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania;2. Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania;3. Department of Radiology, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania;4. Department of Cancer Biology, Perelman School of Medicine, Philadelphia, Pennsylvania;1. Department of Bioethics, Columbia University, 2970 Broadway, New York, NY 10027;2. Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania;3. Division of General Surgery, Einstein Healthcare Network, Philadelphia, Pennsylvania;4. Warren Alpert Medical School of Brown University, Providence, Rhode Island;5. Division of Interventional Radiology, Department of Radiology, Stanford University, Stanford, California;6. Division of Interventional Radiology, Department of Radiology, The Ohio State University Medical Center, Columbus, Ohio;1. Imaging Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Rd., London W12 0HS, United Kingdom;2. Department of Endocrinology and Diabetes, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Rd., London W12 0HS, United Kingdom;3. Department of Thyroid and Endocrine Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, Du Cane Rd., London W12 0HS, United Kingdom |
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| Abstract: | PurposeTo compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease.Material and MethodsThis study was a prospective randomized clinical trial following 33 patients with symptomatic hemorrhoidal disease Grades 2 and 3 who were randomly assigned to 2 different groups: the superior rectal artery embolization group (n = 15) and Ferguson closed hemorrhoidectomy surgical group (n = 14). Four patients were excluded from the analysis. Pain using the visual analog scale and the use of analgesics were evaluated 3 times daily during the first 7 days of the postoperative period. Recurrent symptoms and satisfaction with treatment were also evaluated in the subsequent first, third, sixth, and twelfth months.ResultsThe mean pain during the first bowel movement after the procedure was 6.08 ± 4.41 in the surgery group and 0 in the embolization group (P = .001). The mean use of pain medication was higher in the surgery group (28.92 doses ± 15.78 vs 2.4 doses ± 5.21; P < .001). In the embolization group, the most prevalent preprocedural symptom was bleeding in 14 patients, with complete improvement in 12 (83.3%) patients. Mucus, skin tag, and pruritus were symptoms that showed little improvement in both groups. The frequency of symptoms (bleeding, pain, prolapse, and pruritus) was similar between the groups at 12 months (P = .691). No severe adverse events were observed in both groups.ConclusionsDespite no difference in outcomes, embolization of the superior rectal arteries for the treatment of hemorrhoidal disease showed pain levels lower than those observed after surgical treatment. |
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