DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study

Abstract

SummaryBackgroundUltrasound-guided techniques represent a new treatment option in the treatment of haemorrhoids. Doppler-guided haemorrhoidal artery ligation (DG-HAL) proved efficacious in early haemorrhoidal disease, but lacks efficacy for stages III/IV. For these patients, haemorrhoidal artery ligation (HAL) has been combined with a running suture to reduce prolapsing haemorrhoidal tissue (recto-anal repair (RAR)).MethodsA prospective observational study was conducted in 184 patients with grade III (58 %) or grade IV (42 %) haemorrhoids in seven coloproctological centres. Primary endpoints were the recurrence of symptoms and need of further treatment (medical or surgical).ResultsPost-operative complications were seen in 8 % of patients. After a follow-up of 3 months, 91 % of patients were free of symptoms and 91 % of patients were satisfied with the result. After a follow-up of 12 months, 89 % of patients were free of symptoms and 88 % were satisfied with the result. Nineteen per cent of patients received further medical or surgical treatment.ConclusionsDoppler-guided recto-anal repair (DG-RAR) proves to be an effective treatment option for the treatment of advanced haemorrhoidal disease that shows equal results to other established treatment options.

A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease

“…[1][2][3][4][5][6][7] Dearterialization procedures like hemorrhoid artery ligation have a recurrence rate of 5-18% in various studies. [8][9][10][11][12][13][14][15][16][17][18][19] We didn't have long term results in our study but short term results in our study showed that a single treatment can achieve satisfactory results. If the symptoms of bleeding and prolapse due to hemorrhoids are not relieved, further hemorrhoid ligation or other conservative treatment may be tried.…”

“…It has also been shown to be effective in over 90% of cases, with recurrence of 5-18% in different studies. [8][9][10][11][12][13][14][15][16][17][18][19] In a double blind randomized control trial comparing Doppler guided hemorrhoidal artery ligation and mucopexy with simple ligation of hemorrhoids and mucopexy no advantage was found for the Doppler group.…”

“…Dearterialization of hemorrhoids, either with suture ligation (DGHAL/THD) or laser along with mucopexy for prolapsing hemorrhoids has been studied and found to be safe and effective minimally invasive outpatient treatment for symptomatic hemorrhoids. [8][9][10][11][12][13][14][15][16][17][18][19][20] However the added value of Doppler guidance has recently been challenged in some studies. 11,17,18 Suture ligation of hemorrhoid pedicle without Doppler guidance has been reported by many authors in different studies but it effectiveness and advantages in treatment of hemorrhoids needs to be validated by evidence base.…”

Doppler-guided hemorrhoidal artery ligation with hemorrhoidopexy: source and prevention of postoperative pain

“…According to our data, the first consideration concerns the indication. Some papers extend the indication to the use of the THD with mucopexy technique also for IV grade [8,12,18] considering it safe and effective even in those cases. In our experience, the presence of severe pain was present in a statistically significant level in IV grades cases compared to III grades cases (p value 0.00333) and among those cases who had been subjected to a number of mucopexies greater than 4 (p value 0.034).…”

Possibilities of minimally invasive treatments of hemorrhoidal disease

“…Значительно увеличить эффективность лечения пациентов при поздних стадиях геморроидальной болезни и снизить частоту рецидива пролапса внутренних узлов удалось А. М. Hussein [28] ДДМ у пациентов с 3 и 4 стадиями геморроя. Рецидив кровотечения возник лишь у 2 % пациентов с 3 стадией заболевания и у 11 % больных с 4 стадией, повторное выпадение внутренних узлов отмечали 8 % оперированных с 3 стадией и 18 % -с 4 стадией геморроя.…”