Embolization of the Superior Rectal Arteries versus Closed Hemorrhoidectomy (Ferguson Technique) in the Treatment of Hemorrhoidal Disease: A Randomized Clinical Trial

• Published in: Journal of vascular and interventional radiology Vol. 34; no. 5; pp. 736 - 744.e1
• Main Authors: Falsarella, Priscila Mina, Nasser, Felipe, Affonso, Breno Boueri, Galastri, Francisco Leonardo, Motta-Leal-Filho, Joaquim Mauricio da, Valle, Leonardo Guedes Moreira, Cunha, Marcela Juliano Silva, Araújo, Sergio Eduardo Alonso, Garcia, Rodrigo Gobbo, Katz, Marcelo
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Arteries; Hemorrhage - etiology; Hemorrhoidectomy - adverse effects; Hemorrhoidectomy - methods; Hemorrhoids - surgery; Humans; Neoplasm Recurrence, Local; Pain, Postoperative - diagnosis; Pain, Postoperative - etiology; Pain, Postoperative - prevention & control; Prospective Studies; Treatment Outcome; AE; VAS
• ISSN: 1051-0443; 1535-7732
• DOI: 10.1016/j.jvir.2023.01.022

To compare short-term and medium-term results of superior rectal artery embolization versus surgical hemorrhoidectomy in the treatment of patients with hemorrhoidal disease. This 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. The 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. Despite 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. [Display omitted]