Treatment of Haemorrhoids by Transanal Haemorrhoidal Dearterialization. Experience of Several Specialized Units

Noguerales, F; Dı́az, Raúl; Salim, Basar; Piniella, Fernando; Landaluce, Aitor; Garcea, Alessandro; Pérez, Juan de Mata López

doi:10.1016/j.cireng.2014.04.007

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Transanal HAL or DG-HAL with mucopexy is a minimally invasive technique that is becoming popular. Ratto et al 28 reported the absence of important complications after this procedure; Noguerales et al 29 considered it as a safe and easily reproducible technique associated with a low rate of recurrence and early discharge. Hoyuela et al, 30 Infantino et al, 31 and Sobrado et al 32 reported similar results.…”

Section: Discussionmentioning

confidence: 99%

Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade 3 Hemorrhoidal Disease: the EMODART3 Multicenter Study

Giuliani,

Romano,

Necozione

et al. 2023

Diseases of the Colon &Amp; Rectum

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BACKGROUND: In the last decades, several surgical approaches have been proposed to treat hemorrhoids. OBJECTIVE: This multicenter study aims to compare transanal hemorrhoidal artery ligation and conventional excisional hemorrhoidectomy for grade III hemorrhoidal disease. DESIGN: Multicenter retrospective study. SETTINGS: 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. PATIENTS: Clinical data from patients with Goligher’s grade III hemorrhoidal disease who underwent excisional hemorrhoidectomy or hemorrhoidal artery ligation were retrospectively analyzed after a 24-months follow-up period. MAIN OUTCOME MEASURES: 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 24-months follow-up. RESULTS: Data from 1681 patients were analyzed. The 2 groups resulted to be comparable in terms of postoperative clinical score by multiple regression analysis and matched case-control analysis. Patients submitted to excisional hemorrhoidectomy had a significantly higher risk of postoperative complication (adjusted odds ratio=1.58; p = 0.006). A secondary analysis highlighted that excisional hemorrhoidectomy performed with new devices and hemorrhoidal artery ligation reported significant lower risk for complications then excisional hemorrhoidectomy performed with traditional monopolar diathermy. At the 24-month follow-up assessment, recurrence was significantly higher in hemorrhoidal artery ligation group (adjusted odds ratio=0.50; p = 0.001). A secondary analysis did not show a higher risk of recurrences based on the type of device. LIMITATIONS: The retrospective design and to the self-reported nature of data from different centers. CONCLUSION: Hemorrhoidal artery ligation is an effective option for grade III hemorrhoidal disease; however it is burdened by high risk of recurrences. Excisional hemorrhoidectomy performed with newer devices is competitive in terms of post-operative complications.

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Section: Discussionmentioning

confidence: 99%

Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade 3 Hemorrhoidal Disease: the EMODART3 Multicenter Study

Giuliani,

Romano,

Necozione

et al. 2023

Diseases of the Colon &Amp; Rectum

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Transanal Hemorrhoid Dearterialization is a Safe and Effective Outpatient Procedure for the Treatment of Hemorrhoidal Disease

Bjelanović

Drasković

Veljović

et al. 2016

Cirugía Española (English Edition)

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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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Treatment of Haemorrhoids by Transanal Haemorrhoidal Dearterialization. Experience of Several Specialized Units

Cited by 3 publications

References 21 publications

Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade 3 Hemorrhoidal Disease: the EMODART3 Multicenter Study

Excisional Hemorrhoidectomy Versus Dearterialization With Mucopexy for the Treatment of Grade 3 Hemorrhoidal Disease: the EMODART3 Multicenter Study

Transanal Hemorrhoid Dearterialization is a Safe and Effective Outpatient Procedure for the Treatment of Hemorrhoidal Disease

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

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