Abstract
Objective:To compare Ligation under Vision (LUV) with Ferguson Hemorrhoidectomy (FH) in patients with Grade II, III and IV hemorrhoidal diseases according to their postoperative outcomes.Methods:Between July 2008 and August 2014, 155 patients underwent FH and 120 patients LUV, in Sakarya University Teaching and Research Hospital. Our retrospective analysis focuses on postoperative complications, postoperative pain and rate of recurrence. In LUV procedure, submucosal tissue of the hemorrhoidal pile base was transfixed using absorbable sutures under direct vision through anoscope in the Jackknife position.Results:In a mean postoperative follow-up period of 51.76+/-22.3 months; ectropion, anal fissure, and anal incontinence were the most frequent complications. The overall complication rate was significantly less after LUV than FH, (6.7% vs. 14.2%, P=0.047). The complication rate and need for a second or third surgery did not significantly differ between the two procedures with the increase in affected quadrants (P>0.05). The visual analog scale (VAS) at 24 hours was similar in both groups (P=0.267).Conclusions:LUV is a safe, and practical procedure with similar outcomes compared to FH. LUV may be a better choice than excisional hemorrhoidectomies when three or four quadrants of the anal canal are involved with hemorrhoids as this reduces mucosal defect related possible complications such as ectropion and anal stenosis.
Highlights
Since Morinaga et al first described the Doppler guided Transanal Hemorrhoidal Dearterialization (THD) procedure, it has gained acceptance as a popular non-excisional hemorrhoidectomy operation.[1]
Patients complain of less pain after this procedure, their hospital stay is shorter, and they are able to return to their daily activities much more quickly, This success is likely due to their being no real wound after this procedure in contrast to excisional hemorrhoidectomy techniques.[2,3,4]
Hemorrhoidal cushions involving one quadrant of the anal canal were found in 31 patients (11.3%); 2 quadrants in 96 patients (34.9%); three quadrants in 110 patients (40%), and four quadrants in 38 patients (13.8%). 155 patients (56.4%) underwent Ferguson Hemorrhoidectomy (FH) and 120 patients (43.6%) Ligation under Vision (LUV)
Summary
Since Morinaga et al first described the Doppler guided Transanal Hemorrhoidal Dearterialization (THD) procedure, it has gained acceptance as a popular non-excisional hemorrhoidectomy operation.[1] Patients complain of less pain after this procedure, their hospital stay is shorter, and they are able to return to their daily activities much more quickly, This success is likely due to their being no real wound after this procedure in contrast to excisional hemorrhoidectomy techniques.[2,3,4]. In the original THD procedure, a Doppler transducer is used to localize the supplying arteries of the corpus cavernosum recti in the distal rectum. These arteries are ligated through a specially designed proctoscope. LUV has gained popularity and is performed as one of the regular hemorrhoid operations in our clinic
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