{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:04:19Z","timestamp":1791648259961,"version":"4.3.4"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Over the past few decades, several surgical approaches have been proposed to treat hemorrhoids.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>OBJECTIVE:<\/jats:title>\n            <jats:p>This multicenter study aimed to compare transanal hemorrhoidal artery ligation and conventional excisional hemorrhoidectomy for grade III hemorrhoidal disease.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>DESIGN:<\/jats:title>\n            <jats:p>Multicenter retrospective study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>SETTINGS:<\/jats:title>\n            <jats:p>Any center belonging to the Italian Society of Colorectal Surgery in which at least 30 surgical procedures per year for hemorrhoidal disease were performed was able to join the study.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>PATIENTS:<\/jats:title>\n            <jats:p>Clinical data from patients with Goligher\u2019s grade III hemorrhoidal disease who underwent excisional hemorrhoidectomy or hemorrhoidal artery ligation were retrospectively analyzed after a 24-month follow-up period.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>MAIN OUTCOME MEASURES:<\/jats:title>\n            <jats:p>The primary aims were to evaluate the adoption of 2 different surgical techniques and to compare them in terms of symptoms, postoperative adverse events, and recurrences at a 24-month follow-up.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>Data from 1681 patients were analyzed. The results of both groups were comparable in terms of postoperative clinical score by multiple regression analysis and matched case\u2013control analysis. Patients who underwent excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted OR = 1.58; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.006). A secondary analysis highlighted that excisional hemorrhoidectomy performed with new devices and hemorrhoidal artery ligation reported a significantly lower risk for complications than excisional hemorrhoidectomy performed with traditional monopolar diathermy. At the 24-month follow-up assessment, recurrence was significantly higher in the hemorrhoidal artery ligation group (adjusted OR = 0.50; <jats:italic toggle=\"yes\">p<\/jats:italic> = 0.001). A secondary analysis did not show a higher risk of recurrences based on the type of device.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>LIMITATIONS:<\/jats:title>\n            <jats:p>The retrospective design and the self-reported nature of data from different centers.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Hemorrhoidal artery ligation is an effective option for grade III hemorrhoidal disease; however, it is burdened by a high risk of recurrences. Excisional hemorrhoidectomy performed with newer devices is competitive in terms of postoperative complications.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>\n                                    HEMORROIDECTOM\u00cdA POR ESCISI\u00d3N VERSUS DESARTERIALIZACI\u00d3N CON MUCOPEXIA PARA EL TRATAMIENTO DE LA ENFERMEDAD HEMORROIDAL DE GRADO 3: EL ESTUDIO MULTIC\u00c9NTRICO EMODART3\n                                 <\/jats:bold>\n                              <\/jats:p>\n            <jats:p>\n                                 <jats:bold>ANTECEDENTES:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>En las \u00faltimas d\u00e9cadas se han propuesto varios abordajes quir\u00fargicos para el tratamiento de las hemorroides.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>OBJETIVO:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>Este estudio multic\u00e9ntrico tiene como objetivo comparar la ligadura de la arteria hemorroidal transanal y la hemorroidectom\u00eda por escisi\u00f3n convencional para la enfermedad hemorroidal de grado III.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>DISE\u00d1O:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>Estudio retrospectivo multic\u00e9ntrico.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>\u00c1MBITO:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>Cualquier centro perteneciente a la Sociedad Italiana de Cirug\u00eda Colorrectal en el que se realizaron al menos 30 procedimientos quir\u00fargicos por a\u00f1o para la enfermedad hemorroidal pudo participar en el estudio.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>PACIENTES:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>Los datos cl\u00ednicos de pacientes con enfermedad hemorroidal de grado III de Goligher que se sometieron a hemorroidectom\u00eda por escisi\u00f3n o ligadura de arterias hemorroidales se analizaron retrospectivamente despu\u00e9s de un per\u00edodo de seguimiento de 24 meses.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>PRINCIPALES MEDIDAS DE RESULTADO:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>Los objetivos primarios fueron evaluar la adopci\u00f3n de dos t\u00e9cnicas quir\u00fargicas diferentes y compararlas en t\u00e9rminos de s\u00edntomas, eventos adversos posoperatorios y recurrencias a los 24 meses de seguimiento.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>RESULTADOS:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>Se analizaron datos de 1681 pacientes. Los 2 grupos resultaron ser comparables en t\u00e9rminos de puntuaci\u00f3n cl\u00ednica posoperatoria mediante an\u00e1lisis de regresi\u00f3n m\u00faltiple y an\u00e1lisis de casos y controles emparejados. Los pacientes sometidos a hemorroidectom\u00eda excisional tuvieron un riesgo significativamente mayor de complicaciones posoperatorias (odds ratio ajustado = 1,58; p = 0,006). Un an\u00e1lisis secundario destac\u00f3 que la hemorroidectom\u00eda por escisi\u00f3n realizada con nuevos dispositivos y la ligadura de la arteria hemorroidal informaron un riesgo significativamente menor de complicaciones que la hemorroidectom\u00eda por escisi\u00f3n realizada con diatermia monopolar tradicional. En la evaluaci\u00f3n de seguimiento de 24 meses, la recurrencia fue significativamente mayor en el grupo de ligadura de la arteria hemorroidal (raz\u00f3n de probabilidad ajustada = 0,50; p = 0,001). Un an\u00e1lisis secundario no mostr\u00f3 un mayor riesgo de recurrencias seg\u00fan el tipo de dispositivo.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>LIMITACIONES:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>El dise\u00f1o retrospectivo y el car\u00e1cter autoinformado de los datos de diferentes centros.<\/jats:p>\n            <jats:p>\n                                 <jats:bold>CONCLUSI\u00d3N:<\/jats:bold>\n                              <\/jats:p>\n            <jats:p>HAL es una opci\u00f3n efectiva para la enfermedad hemorroidal grado III; sin embargo, se ve afectado por un alto riesgo de recurrencias. La hemorroidectom\u00eda por escisi\u00f3n realizada con dispositivos m\u00e1s nuevos es competitiva en t\u00e9rminos de complicaciones posoperatorias. <jats:italic toggle=\"yes\">(Traducci\u00f3n\u2014Dr Yolanda Colorado<\/jats:italic>)<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/dcr.0000000000002885","type":"journal-article","created":{"date-parts":[[2023,8,24]],"date-time":"2023-08-24T17:07:12Z","timestamp":1692896832000},"page":"e1254-e1263","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":6,"title":["Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade III Hemorrhoidal Disease: The EMODART3 Multicenter Study"],"prefix":"10.1097","volume":"66","author":[{"given":"Antonio","family":"Giuliani","sequence":"first","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"},{"name":"Department of General Surgery, San Salvatore Hospital, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Romano","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Necozione","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Cofini","sequence":"additional","affiliation":[{"name":"Biostatistics and Epidemiology Unit, Department of Life, Health and Environmental Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giada","family":"Di Donato","sequence":"additional","affiliation":[{"name":"Department of General Surgery, San Salvatore Hospital, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Schietroma","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"},{"name":"Department of General Surgery, San Salvatore Hospital, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Carlei","sequence":"additional","affiliation":[{"name":"Department of Biotechnological and Applied Clinical Sciences, University of L\u2019Aquila, L\u2019Aquila, Italy"},{"name":"Department of General Surgery, San Salvatore Hospital, L\u2019Aquila, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"On behalf of the EMODART3 Study 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A case series of 117 consecutive patients.","volume":"30","author":"Medina-Gallardo","year":"2017","journal-title":"Int J Surg Case Rep"},{"key":"R14-20250505","first-page":"610","article-title":"A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter.","volume":"90","author":"Morinaga","year":"1995","journal-title":"Am J Gastroenterol"},{"key":"R15-20250505","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s10151-007-0376-4","article-title":"Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease.","volume":"11","author":"Dal Monte","year":"2007","journal-title":"Tech Coloproctol"},{"key":"R16-20250505","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1007\/DCR.0b013e3181af50f4","article-title":"Transanal hemorrhoidal dearterialization: a systematic review.","volume":"52","author":"Giordano","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"R17-20250505","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1097\/DCR.0000000000000085","article-title":"A prospective, randomized trial comparing the short- and long-term results of Doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids.","volume":"57","author":"De Nardi","year":"2014","journal-title":"Dis Colon Rectum"},{"key":"R18-20250505","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s12893-019-0469-9","article-title":"Doppler-guided transanal hemorrhoidal dearterilization versus conventional hemorrhoidectomy for treatment of hemorrhoids\u2014early and long-term postoperative results.","volume":"19","author":"Popov","year":"2019","journal-title":"BMC Surg"},{"key":"R19-20250505","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1097\/DCR.0b013e31827a8567","article-title":"A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids.","volume":"56","author":"Elm\u00e9r","year":"2013","journal-title":"Dis Colon Rectum"},{"key":"R20-20250505","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"61","author":"von Elm","year":"2008","journal-title":"J Clin Epidemiol"},{"key":"R21-20250505","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s13304-021-01010-w","article-title":"Changes in surgicaL behaviOrs dUring the CoviD-19 pandemic. 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Experience of several specialized units.","volume":"93","author":"Noguerales","year":"2015","journal-title":"Cir Esp"},{"key":"R30-20250505","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.ijsu.2016.02.030","article-title":"HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up.","volume":"28","author":"Hoyuela","year":"2016","journal-title":"Int J Surg"},{"key":"R31-20250505","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/j.1463-1318.2009.01915.x","article-title":"Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study.","volume":"12","author":"Infantino","year":"2010","journal-title":"Colorectal Dis"},{"key":"R32-20250505","doi-asserted-by":"crossref","first-page":"e1504","DOI":"10.1590\/0102-672020190001e1504","article-title":"Transanal haemorrhoidal dearterialization with mucopexy (THD-M) for treatment of hemorrhoids: is it applicable in all grades? 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