Efficacy of Doppler-guided hemorrhoidal artery ligation with mucopexy, in the short and long terms for patients with hemorrhoidal disease

Ferrandis, Charlotte; Faucal, D. de; Fabreguette, J.-M.; Borie, F.

doi:10.1007/s10151-019-02136-1

Cited by 22 publications

(15 citation statements)

References 18 publications

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“…In previous prospective randomized trials comparing DG HAL and EH, DG HAL produce less operative pain and morbidity with a similar long-term recurrence rate and report similar chronic complications after hemorrhoidectomy alone (5,6). Carvajal-López et al compared DG-HAL-RAR (doppler guided transanal hemorrhoidal artery ligation with recto-anal repair) with EH and found that the early postoperative pain was less in the group that underwent hemorrhoidal artery ligation (5).…”

Section: Discussionmentioning

confidence: 97%

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Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

et al. 2021

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The objective of this work was to analyze the results of the hemorrhoidal artery ligation technique without using a doppler guide, in patients with grade 3 hemorrhoidal disease; by evaluating cost-effectiveness, operation time, recurrence rate, postoperative pain, and secondary outcomes. A hemorrhoidal artery ligation procedure, without using a doppler guide, was performed on 43 patients (15 females, 28 males) with grade 3 symptomatic hemorrhoidal disease, from June 2015 to June 2019, in the Haseki Training and Research Hospital, Istanbul, Turkey. Patients were followed up clinically for one month. They completed a questionnaire within one year after their procedure. The median age was 46 years (range: 24 to 82 years). The main complaints were bleeding in 27 patients, pain in 22 patients, and skin tag in 14 patients. The mean preoperative VAS score was 3.4. The mean operating time was 18 mins (range: 13 to 25 min). All patients remained hospitalized for 24 h. Reoperation was necessary for only one patient because of bleeding. One year after the surgery, the pain was resolved in 21 (95.4%) out of 22 patients with preoperative pain, and bleeding resolved in 25 (92.5%) out of 27 patients with preoperative bleeding. The hemorrhoidal artery ligation is a simple method with a shorter learning curve producing similar postoperative results to other surgical procedures. The surgical technique is cost-effective as it does not require any particular device (anoscope with Doppler ultrasound) to apply.

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Section: Discussionmentioning

confidence: 97%

“…Studies that compare DG HAL and EH show that postoperative pain was lower and symptom resolution was significantly higher in the DG HAL procedure. No differences have been found in morbidity and recurrence rate (5,6).…”

Section: Introductionmentioning

confidence: 94%

Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

et al. 2021

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“…8,11 The DGHD þ M technique represents one of the surgical options used. 8,[16][17][18][19] Despite the advantages of the method regarding the reduction of postoperative pain and faster return of the patient to social life, some symptoms related to the greater number of sutures performed in the DGHD þ M technique, often unnecessary, and the highest rates of recurrence of the disease, are still outcomes that satisfy the doctor and the patient. 19 A recent study using the DGHD þ M technique that evaluated 1,000 patients showed recurrence rates in HD grades II, III and IV of 8.5, 8.7, and 18.1%, respectively; 20 3.1% of patients had tenesmus and 7% had surgery for recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The studied symptoms (pain, hemorrhoidal prolapse, bleeding and local discomfort) improved immediately after surgery. 18 When analyzing the objectives of the DGHD þ M and SHeLF techniques, the two procedures were designed with the objective of curing HD considering the two main etiopathogenic factors: blood hyperflow and mucous prolapse. Both procedures disrupt arterial blood flow to the hemorrhoidal venous plexus and fix the excess of prolapsed rectal mucosa, resessecting the plicoma when necessary.…”

Section: Discussionmentioning

confidence: 99%

Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease

Rotta

Drago

Sousa

et al. 2021

Journal of Coloproctology

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The doppler-guided transanal hemorrhoidal dearterialization technique associated with mucopexy is a noninvasive surgical option used to treat hemorrhoidal disease (HD). Objective To compare and analyze the results using a variation of the doppler-guided transanal hemorrhoidal dearterialization technique with the technique of selective hemorrhoidal dearterialization with high mucopexy in the treatment of HD. Method A total of 292 patients who underwent surgical treatment for grade II, III and IV HD from March 2012 to December 2017 were studied. From this total, 110 (37.6%) patients underwent a conventional doppler-guided transanal hemorrhoidal dearterialization with mucopexy (CD), and 182 (62.3%) underwent selective hemorrhoidal dearterialization with high mucopexy (SHeLF). In the group of patients undergoing CD, 4 patients (3.64%) had grade II HD, 82 (74.55%) grade III, and 24 (21.82%) grade IV. In the group submitted to SHeLF, 18 (9.89%) patients had grade II HD, 86 (47.25%) had grade III, and 65 (35.71%) had grade IV. The same surgeon operated all patients under spinal anesthesia. In patients undergoing CD, six arterial branches have been dearterialized, while in patients undergoing SHeLF, the hemorrhoidary nipples submitted to a dearterialization were selected (from 1 to 5) by intraoperative evaluation followed by high rectal mucopexy. In the postoperative period, the following parameters were evaluated: pain, tenesmus, bleeding, and recurrence.Moderate results to severe pain was a postoperative complaint reported by 13 (11.82%) patients undergoing CD, and by 19 (10.44%) undergoing SHeLF. Intense tenesmus was reported by 26 (23.64%) patients undergoing CD and by 7 (3.85%) undergoing SHeLF. Three patients (2.73%) undergoing CD and 1 (0.55%) undergoing SHeLF evolved with postoperative bleeding. One patient (0.55%) in the group undergoing CD required surgical review of hemostasis. Six patients (5.45%) who underwent CD and 8 (4.39%) who underwent SHeLF were reoperated due to disease recurrence. Conclusion Comparing statistics, patients undergoing the SHeLF technique have less postoperative pain, tenesmus and postoperative bleeding when compared with CD.

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“…Некоторые авторы [16] убеждены, что необходимо лигировать от 6 до 8 ГА (минимум 6), причем некоторые исследователи [17] подчеркивают необходимость лигирования до 16 найденных артерий (от 4 до 16, в среднем -9). Однако даже в этом случае рецидив в течение 5 лет после операции возможен в 35,6% [18].…”

Section: таблица 2 оценка эффективности лечения: первичные и вторичные точкиunclassified

Haemorrhoidal artery ligation with and without Doppler guidance in the treatment of haemorrhoidal disease: a single-centre randomized study

Tsarkov

Popovtsev

Медкова

et al. 2021

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Aim. To evaluate the efficacy of haemorrhoidal artery ligation (HA) with a preliminary palpatory determination of its localization supplemented by mucopexy of haemorrhoids as a new surgical method in the treatment of haemorrhoidal disease (HD) and to compare it with HAL-RAR technology.Materials and methods. The randomized controlled clinical trial included patients over 18 years old with Goligher’s grade II, III or IV symptomatic HD. We operated on patients in the study group (n = 75) using palpatory determination of the localization of HA and subsequent mucopexia. In the control group (n = 75) we used HAL-RAR. The primary endpoint (25–30 days after surgery): recurrence rate of HD symptoms. Secondary endpoints: postoperative complication rate, pain intensity on a visual-analogue scale from 1 to 10 points, patient satisfaction with the treatment results on a 10-point scale.Results. According to the initial characteristics (age, gender, body mass index, stage of HD, frequency of clinical symptoms), the groups did not differ. Anal bleeding relapse developed: study group – 11%, control group –14%; relapse of haemorrhoids prolapse: 3% and 5% respectively (p > 0.05). Postoperative complications were noted in 6 (8%) in the study group and 4 (5%) in the control group (p > 0.05). The intensity of pain on the 2nd and 25–30 days after surgery was 6.3 [4.8; 7.4] and 1.2 [0.6; 2.5] points in the study group and 6.5 [4.9; 7.3] and 2.1 [1.9; 4.1] in the control group, respectively (p > 0.05). Patient satisfaction with the treatment results after 12 months was estimated at 8.7 [7.9; 9.2] and 9.4 [8.2; 9.6] in the study and control groups, respectively (p > 0.05).Conclusion. HA ligation with a preliminary palpatory determination of its localization and supplemented with mucopexy of haemorrhoids is no less effective than HAL-RAR in preventing haemorrhoidal bleeding and prolapse of the nodes.

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Efficacy of Doppler-guided hemorrhoidal artery ligation with mucopexy, in the short and long terms for patients with hemorrhoidal disease

Cited by 22 publications

References 18 publications

Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease

Haemorrhoidal artery ligation with and without Doppler guidance in the treatment of haemorrhoidal disease: a single-centre randomized study

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