Modified ligation procedure or stapled haemorrhoidectomy, which is better for treating symptomatic hemorrhoids?
China: Modified ligation procedure for prolapsed hemorrhoids (MLPPH) is documented to be a cost-effective approach compared to stapled haemorrhoidectomy (SH), a recent study in BJS Open has revealed.
MLPPH was, however, a longer procedure that provided short-term pain, achieved a better clinical therapeutic effect, and lower Wexner and hemorrhoid severity scores than SH for the treatment of symptomatic hemorrhoids.
The study was conducted by Wei Chen, Shanghai University of Traditional Chinese Medicine, Shanghai, P.R. China, and colleagues with the objective compare a modified ligation procedure versus stapled haemorrhoidectomy in patients with symptomatic hemorrhoids.
The randomized trial included patients with symptomatic hemorrhoids treated in Shanghai from May 2018 to September 2021. 133 patients were randomly assigned in a ratio of 1:1 to receive a ligation procedure for prolapsed hemorrhoids (MLPPH; n=67) and SH (n=66).
The assessment of efficacy 6 months after the intervention was the study's primary outcome. Incidence of complications, operating time, clinical effectiveness (pain, Wexner incontinence, hemorrhoid symptom severity (HSS) scores, and 6-month cure rate) were collected. Adoption of quality-adjusted life years (QALYs) was done as an indicator for the cost-effectiveness analysis (CEA).
The study revealed the following findings:
- One patient in the MLPPH group was excluded, and two patients were lost to follow-up.
- The mean operating time was longer in MLPPH than in SH (57.42 min versus 30.68 min).
- The median pain score was higher in SH than in MLPPH at postoperative day 3, day 7, and day 14.
- The median Wexner incontinence score was higher in SH than in MLPPH at postoperative month 1 and month 3, but was similar in the two groups at month 6.
- The median HSS score was lower in MLPPH than in SH 6 months after surgery.
- The 6-month cure rate was higher in MLPPH than in SH.
- CEA showed lower mean costs in MLPPH than in SH (EUR 1080.24 versus EUR 1657.97) but there was no significant difference in effectiveness.
- MLPPH was cost-effective (incremental cost-effectiveness ratio, −120 656.19 EUR/QALYs).
The authors concluded by stating that, "MLPPH was documented as a longer but the cost-effective procedure, it provided lower short-term pain, and Wexner and HSS scores."
Reference:
Haibo Yang, Zhan Shi, Wei Chen, Teng Chen, Peilin Ding, Jandong Wang, Jiazhi Gao, Modified ligation procedure for prolapsed haemorrhoids versus stapled haemorrhoidectomy for the management of symptomatic haemorrhoids (MoLish): randomized clinical trial, BJS Open, Volume 6, Issue 3, June 2022, zrac064, https://doi.org/10.1093/bjsopen/zrac064
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