Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal Repair Outcome on Female Patients in Basra: Assessment Study Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal Repair Outcome on Female Patients in Basra: Assessment Study

Main Article Content

Ohood S. Leabi
Alaa H. Abed
Wafa S. Al-Maliki

Keywords

Hemorrhoidectomy, Anal surgery, DG-HAL-RAR, Basrah

Abstract

Background: Hemorrhoidal disease is a common morbidity seen by general surgery clinics. Transanal Doppler guided (DG) hemorrhoidal artery ligation (HAL) with rectoanal repair (RAR) has been invented as a new treatment option. HAL-RAR was associated with mild to moderate postoperative complications in the literatures; and considered easy, safe, mostly painless procedure with very good results in treating hemorrhoids.


Objective: This study was conducted to evaluate the outcome of using DG-HAL-RAR procedure through documenting postoperative complications during a median follow-up period of 18 months.


Method: The study included 151 women presented with hemorrhoids in Basra, operated upon using the DG-HAL-RAR and complications assessed.


Results: The patients’ mean age was 40–99 years. Most of the hemorrhoids were internal plus external (86.1%), of third degree (68.2%) and non-recurrent (90.1%). The surgical management needed an average of 6 ligations and 3 mucopexies. During the follow up periods, the most frequent complication was early bleeding, while the least was hemorrhoids recurrence.


Discussion: During the follow up period, the postoperative complications were early bleeding, early pain, urine retention, late bleeding, anal stenosis, and hemorrhoids recurrence, the incidence of which were similar or close to the incidence of documented by other studies, except for early bleeding which was much higher than in our study. Some complications, reported by other studies,were not reported in this study.


Conclusions: DG-HAL-RAR procedure can be used effectively and safely in second or third degree hemorrhoids.


 


Keywords: Hemorrhoidectomy, Anal surgery, DG-HAL-RAR, Basra

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References

1. Liu Z, Song X, Ye F (2019) Comparative Study of Postoperative Complications after Rubber Band Ligation (RBL) and RBL Combined with Sclerotherapy in Treatment of Second- and Third-Degree Internal Hemorrhoids. Indian J Surg. https://doi.org/10.1007/s12262-019-01959-4
2. Shukla S, Maheshwari A, Tiwari B (2018) Randomized Trial of Open Hemorrhoidectomy Versus Stapled Hemorrhoidectomy for Grade II/III Hemorrhoids. Indian J Surg. 80:574–579. https://doi.org/10.1007/s12262-017-1670-7
3. Johansson HO, Pahlman L, Graf W (2013) Functional and structural abnormalities after Milligan hemorrhoidectomy: a comparison with healthy subjects. Dis. Colon Rectum 56 (7):903-908
4. Zagryadskiy EA, Gorelov SI (2011) Transanal Doppler-guided hemorrhoidal artery ligation and recto anal repair vs closed hemorrhoidectomy for treatment of degree I-IV hemorrhoids. A randomized trial. Pelviperineology 30:107-112
5. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am. J. Gastroenterol 90:610-613
6. Banai Z, Harkai Z, Király L, Szekeres P, Ottlecz I (2019) HAL-RAR for the treatment of hemorrhoids - a new, non invasive method. Magy Seb. 72(4):161-166. doi: 10.1556/1046.72.2019.4.2.
7. Walega P, Krokowicz P, Romaniszyn M, Kenig J, Sałówka J, Nowakowski M, Herman RM, Nowak W (2010) Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease. Colorectal Dis. 12(10 Online):e326-9. doi: 10.1111/j.1463-1318.2009.02034.x.
8. Walega P, Romaniszyn M, Kenig J, Herman R, Nowak W (2012) Doppler-guided hemorrhoid artery ligation with recto-anal-repair modification: functional evaluation and safety assessment of a new minimally invasive method of treatment of advanced hemorrhoidal disease. Scientific World Journal 2012: 324040.
9. Roka S, Gold D, Walega P, Lancee S, Zagriadsky E, Testa A, Kukreja A.N, Salat A (2013) DG-RAR for the treatment of symptomatic degree I and degree II hemorrhoids: a 12 month multi-centre, observational study. Eur. Surg, 45:26-30
10. Forrest NP, Mullerat J, Evans C, Middleton SB (2010) Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids. Int J Colorectal Dis. 25(10):1251-6. doi: 10.1007/s00384-010-0951-4. Epub 2010 Apr 22
11. Hoyuela C, Carvajal F, Juvany M, Troyano D, Trias M, Martrat A, Ardid J, Obiols J (2016) HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a study after two-years follow-up. International Journal of Surgery 28:39-44
12. Roka S, Gold D, Walega P, Lancee S, Zagriadsky E, Testa A, Kukreja AN, Salat A (2013) DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, observational study. Eur Surg. 45(1):26–30
13. Jeong WJ, Cho SW, Noh KT, Chung SS (2011) One year follow-up result of Doppler-guided hemorrhoidal artery ligation and recto-anal repair in 97 consecutive patients. J Korean Soc Coloproctol. 27(6):298–302
14. Williams NS, O'connell PR, McCaskie AW (2018) Bailey & Love's Short Practice of Surgery, 27th edn. Florida: Taylor & Francis Group, p 1355
15. Trilling B, Mancini A, Reche F, Pflieger H, Sage PY, Faucheron JL (2019) Assessment of Haemorrhoidal Artery Network Using Doppler-guided Haemorrhoidal Artery Ligation for Haemorrhoids and Pathogenesis Implications ANZ J Surg 89(7-8):E288-E291. doi: 10.1111/ans.15143. Epub 2019 Jul 1.
16. Shehata, AM, Saleh, AF, El-Heeny, AAE (2019) Clinical Outcome after Doppler-Guided Hemorrhoidal Artery Ligation and Rubber Band Ligation for Treatment of Primary Symptomatic Hemorrhoids. Indian J Surg 81:332–337. https://doi.org/10.1007/s12262-018-1797-1
17. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y (2011) Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal Repair (HAL-RAR) for the Treatment of Grade IV Hemorrhoids: Long-Term Results in 100 Consecutive Patients. Diseases of the Colon & Rectum 54(2):226-31. DOI: 10.1007/DCR.0b013e318201d31c
18. Testa A, Torino G, Gioia A (2010) DG-RAR (Doppler-guided Recto-Anal Repair): A New Mini Invasive Technique in the Treatment of Prolapsed Hemorrhoids (Grade III-IV): Preliminary Report. Int Surg 95(3):265-9.
19. Sister, Horton Day Case Unit (2017, reviewed 2020) Oxford University Hospitals, NHS Foundation Trust Oxford, www.ouh.nhs.uk/information
20. López FC, Alonso CH, Gómez MJ, Escribano DT, Bisbal MAT, Macià AM, Brito JA (2019) Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life. Surg Innov 26(3):328-336. doi: 10.1177/1553350618822644. Epub 2019 Jan 9.
21. Scheyer M, Antonietti E, Rollinger G, Lancee S, Pokorny H (2015) Hemorrhoidal Artery Ligation (HAL) and Rectoanal Repair (RAR): Retrospective Analysis of 408 Patients in a Single Center. Tech Coloproctol, 19 (1):5-9. doi: 10.1007/s10151-014-1246-5. Epub 2014 Nov 19.
22. Chongouki CF, Doulgerakis G, Pantelis A, Vidali M, Papaioannou G, Iordanou C, Pougouras I, Palyvos L, Papandrikos I, Pierrakakis S (2013) Remarks and results from the use of the HAL/RAR technique in the management of patients with haemorrhoids. Hellenic Journal of Surgery 85(4):274-279. DOI: 10.1007/s13126-013-0052-2
23. Sherif TM, Sarhan AEA (2016) Doppler-guided hemorrhoidal artery ligation with recto-anal repair versus Milligan Morgan hemorrhoidectomy for grade IV hemorrhoids. The Egyptian Journal of Surgery, 35 (3): 155-161
24. Zindel J, Inglin R, Brügger L (2014) Necessary and Unnecessary Treatment Options for Hemorrhoids. Ther Umsch 71(12):737-51. doi: 10.1024/0040-5930/a000620
25. Satzinger U, Feil W, Glaser K (2009) Recto Anal Repair (RAR): a viable new treatment option for high-grade hemorrhoids. One year results of a prospective study. Pelviperineology, 28:37-42. http://www.pelviperineology.org
26. Trilogy, Product Group Coloproctology. Issue 2/ 2017. www.tsc-nl.com
27. Ahmad A, Kant R, Gupta A (2013) Comparative Analysis of Doppler Guided Hemorrhoidal Artery Ligation (DG-HAL) & Infrared Coagulation (IRC) in Management of Hemorrhoids. Indian Journal of Surgery 75:274–277
28. Rodoman GV, Kornev LV, Shalaeva TI, Malushenko RN (2017) Efficiency of Combined Methods of Hemorroid Treatment Using HAL-RAR and Laser Destruction. Khirurgiia (Mosk) (5):47-51. doi: 10.17116/hirurgia2017547-51.
29. Markaryan D, Tulina I, Garmanova T, Bredikhin M, Alikperzade A, Tsarkov F (2020) Hemorrhoidal Artery Ligation With Doppler Guidance vs Digital Guidance for Grade II-III Hemorrhoidal Disease Treatment: Study Protocol Clinical Trial (SPIRIT Compliant). Medicine (Baltimore) 99(15):e19424. doi: 10.1097/MD.0000000000019424.
30. Lienert M (2018) Literature Review on Dearterialization of Hemorrhoids and Mucopexy. Hemorrhoids pp 415-447. Online: 06 June 2018

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