Abstract
SHORT TERM OUTCOME OF DOPPLER GUIDED HEMORRHOIDAL ARTERY LIGATION AND RECTO-ANAL REPAIR IN COMPARISON WITH CONVENTIONAL OPEN HEMORRHOIDECTOMY AS A TREATMENT METHOD FOR PROLAPSED HEMORRHOIDS. Sadq Ghaleb Kadem MB, ChB, FICMS, General Surgeon, Al-Shiffa General Hospital, Basrah, IRAQ. Abstract Conventional hemorrhoidectomy is the most common surgical procedure used to treat hemorrhoids, but it is associated with significant side effects and complications. Doppler-guided hemorrhoidal artery ligation and recto-anal repair is a new minimally invasive treatment option to avoid the complications of conventional hemorrhoidectomy. This study aimed to evaluate the short term outcome of doppler-guided hemorrhoidal artery ligation and recto-anal repair in comparison with conventional open hemorrhoidectomy as a method for treating patients with prolapsed hemorrhoids. This study was conducted at Al-Shiffa General Hospital in Basrah, Iraq, during the period from January 2015 to December 2016. One hundred patients with symptomatic hemorrhoids who are candidates for surgery were included in the study and were divided into two equal groups; the first group operated upon with conventional open hemorrhoidectomy and the second group operated upon with doppler guided hemorrhoidal artery ligation and recto anal repair technique which utilizes a special doppler ultrasound proctoscope to identify and ligate the hemorrhoidal arteries and to gather up and lift back into position. Both groups were similar in patients characteristics, all operations have been done under general or spinal anesthesia and in lithotomy position by the same surgeon. During intra and postoperative periods of follow-up, the outcome and the complications of both procedures were analyzed statistically and compared. Doppler guided hemorrhoidal artery ligation and recto-anal repair technique significantly reduce postoperative pain and according to the Visual Analogue Scale; the majority of patients (64%) in doppler guided hemorrhoidal artery ligation and recto anal repair group have no pain at the night of the surgery while 82% of patients in conventional open hemorrhoidectomy group complained of moderate pain. It also significantly reduce the mean duration to return to normal daily activity to 5.44±2.02 days in comparison to 15.40±4.18 days for conventional open hemorrhoidectomy (p
Highlights
Hemorrhoids are defined as mucosal cushions and are considered as a part of normal anatomy of human anal canal[1]
Technique of conventional open hemorrhoidectomy: After anal dilatation, the hemorrhoid grasped with two artery forceps, a V–shape incision done on the skin component and extended proximal until the vascular pedicle of hemorrhoid which transfixed with 2/0 vicryl suture before excision
This study evaluate the short term outcome of the new minimally invasive procedure Doppler-guided hemorrhoidal artery ligation (DGHAL)-RAR in comparison with the conventional open hemorrhoidectomy in treatment of grade II, III and IV hemorrhoid
Summary
Hemorrhoids are defined as mucosal cushions and are considered as a part of normal anatomy of human anal canal[1]. The normal anal canal contains three main cushions, classically located at left lateral, right anterior, and right posterior position, they are composed of sinusoids, connective tissue and smooth muscle and known as the hemorrhoidal plexus[2,3]. Hemorrhoidal cushions play important role in continence mechanism of the anal canal. When the intraabdominal pressure increase, hemorrhoidal cushions increase in bulging helping to maintain anal closure[4]. Grade II: Prolapse on defecation, but spontaneous reduction. Grade III: Prolapse on defecation requiring manual reduction. Grade IV: Prolapse with inability to be manually reduced. Surgery is reserved for high grade hemorrhoids[8 ]
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