Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial

Perivoliotis, Konstantinos; Spyridakis, M.; Ζιντζαράς, Ηλίας; Αrnaoutoglou, Eleni; Pramateftakis, Manousos-Georgios; Tepetes, Konstantinos

doi:10.1007/s00384-020-03768-8

Cited by 3 publications

(3 citation statements)

References 48 publications

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“…Omitting Doppler localization of arteries and blind ligation is becoming popular in the literature. The significance of present study is the location of blind HAL, which is different from a previous report [ 19 ]. This previous study ligated the vessels in 3 points, but regarding previous observations detecting the pulse in 6 points, we intended to perform ligation at 6 points.…”

Section: Discussioncontrasting

confidence: 98%

“…Recent study demonstrates the possibility of HAL without use of Doppler [ 19 ] and this study showed the possibility of this approach and adding Doppler did not change the outcome significantly.…”

Section: Introductionmentioning

confidence: 55%

“…As described previously, other modifications in DG-HAL-RAR method is published in the literature. Mucopexy alone has been shown to be effective in treating patient symptoms [ 27 ] blind HAL also used [ 19 ] and seems to be effective in treating hemorrhoid symptoms.…”

Section: Discussionmentioning

confidence: 99%

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Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome

et al. 2023

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Purpose: Hemorrhoids are the most common benign anorectal diseases. Mucopexy strengthens the anal canal mucosa, which can be performed alone or in combination with Doppler-guided hemorrhoidal artery ligation (DG-HAL). In this study, we compared the postoperative complications between simple mucopexy plus HAL with and without a Doppler guide.Methods: This study was performed as a single-blinded randomized clinical trial. Patients referred to a tertiary colorectal referral clinic with grades 3 and 4 hemorrhoids who were candidates for surgical intervention entered the study. Thirty-six patients were randomly divided into 2 groups. Group A including 18 patients underwent mucopexy and DG-HAL and the other 18 patients (group B) underwent standard mucopexy and HAL without a Doppler guide. Postoperative pain score and the duration of oral analgesic consumption were recorded. Additionally, postoperative symptoms and complications were recorded and compared between the 2 methods.Results: There was no significant difference between the 2 groups in terms of pain score and the duration of postoperative analgesic consumption as well as the incidence of postoperative complications. Besides, the primary grade of hemorrhoids was not significantly associated with recurrence, but there was a significant association between body mass index and Wexner score (WS) with recurrence. The mean WS of patients showed a significant decrease in both groups postoperatively. However, the rate of WS reduction was not remarkably different between the 2 groups.Conclusion: Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.

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Section: Discussioncontrasting

confidence: 98%

Section: Introductionmentioning

confidence: 55%

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Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome

et al. 2023

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PROSPECT guideline for haemorrhoid surgery

Bikfalvi,

Faes,

Freys

et al. 2023

European Journal of Anaesthesiology Intensive Care

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BACKGROUND Haemorrhoidectomy is associated with moderate-to-severe postoperative pain. OBJECTIVE The aim of this systematic review was to assess the available literature and update previous PROSPECT (procedure specific postoperative pain management) recommendations for optimal pain management after haemorrhoidectomy. DESIGN AND ELIGIBILITY CRITERIA A systematic review utilising PROSPECT methodology was undertaken. DATA SOURCES Randomised controlled trials published in the English language from January 1, 2016 to February 2, 2022 assessing postoperative pain using analgesic, anaesthetic, and surgical interventions were identified from MEDLINE, EMBASE and Cochrane Database. RESULTS Of the 371 randomized controlled trials (RCTs) identified, 84 RCTs and 19 systematic reviews, meta-analyses met our inclusion criteria (103 publications). Interventions that improved postoperative pain relief included: paracetamol and nonsteroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, pudendal nerve block, topical metronidazole, topical diltiazem, topical sucralfate or topical glyceryl trinitrate, and intramuscular injection of botulinum toxin. DISCUSSION This review has updated the previous recommendations written by our group. Important changes are abandoning oral metronidazole and recommending topical metronidazole, topical diltiazem, topical sucralfate, topical glyceryl trinitrate. Botulinum toxin can also be administered. Contemporary publications confirm the analgesic effect of bilateral pudendal nerve block but invalidate recommendations on perianal infiltration. The choice of the surgery is mostly left to the discretion of the surgeons based on their experience, expertise, type of haemorrhoids, and risk of relapse. That said, excisional surgery is more painful than other procedures.

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Haemorrhoid artery ligation – recto anal repair (HAL‐RAR) blind versus Doppler: a systematic review and meta‐analysis

Liew,

Wang,

Chen

et al. 2024

ANZ Journal of Surgery

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BackgroundHaemorrhoids remain a highly prevalent condition in Australia, affecting 39% of the adult Australian population. While haemorrhoidectomy remains the gold standard in the management of haemorrhoids, newer techniques such as haemorrhoid artery ligation‐recto anal repair (HAL‐RAR) are emerging as promising management modalities. We compare the efficacy of non‐Doppler guided (non‐DG) HAL‐RAR versus Doppler‐guided (DG) HAL‐RAR in the management of haemorrhoids.MethodsThis study was registered with PROSPERO (CRD42022353806) and adhered to PRISMA 2020 guidelines. We conducted a systematic review using Medline, Embase and Cochrane database for comparative studies between Doppler‐guided HAL‐RAR and non‐Doppler‐guided HAL‐RAR in accordance with the PRISMA 2020 statement for reporting systematic reviews.ResultsFive studies were included in our systematic review and meta‐analysis. There was no clinically significant difference in operative times (SMD 0.46, 9% CI −3.16 0 4.08, P = 0.804) or post‐operative bleeding (P = 0.142) between the two groups. DG HAL‐RAR patients were more likely to have post‐operative urinary retention (P < 0.001). Non‐DG patients were less likely to experience recurrence (OR 5.12, P < 0.001).ConclusionOur review of non‐DG HAL‐RAR compared to DG HAL‐RAR reflects the non‐inferiority of the non‐DG HALRAR procedure. We hope that these results would provide a guide to clinicians performing HAL‐RAR, and would provide some cost savings for institutions who are unable to procure the necessary equipment for DG HAL‐RAR.

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Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial

Cited by 3 publications

References 48 publications

Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome

Simple mucopexy and hemorrhoidal arterial ligation with and without Doppler guide: a randomized clinical trial for short-term outcome

PROSPECT guideline for haemorrhoid surgery

Haemorrhoid artery ligation – recto anal repair (HAL‐RAR) blind versus Doppler: a systematic review and meta‐analysis

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