Doppler-guided Hemorrhoidal Artery Ligation Research Articles

Exploring factors impacting patient decisions in hemorrhoid surgery: A questionnaire survey in Taiwan

BackgroundMinimally invasive hemorrhoid surgeries like Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) and Stapled Hemorrhoidopexy (PPH) offer benefits over traditional methods. This study investigated public perceptions and attitudes towards these surgeries, exploring awareness, preferences, and influencing factors. MethodsA detailed questionnaire was disseminated to 2011 participants from various regions of Taiwan in December 2023, gathering data on demographics, understanding of minimally invasive surgery, and attitudes towards hemorrhoid surgery. Chi-square tests were used for analysis (p < 0.05). ResultsHemorrhoid prevalence was similar across sexes and age groups. About 70 % preferred medical centers or district hospitals for surgery. Postoperative complications were a primary concern, with significant sex differences. Approximately 70 % preferred minimally invasive surgery if costs were below NT$50,000. Medical personnel showed higher awareness of minimally invasive surgery benefits. Most participants relied on personal networks and medical social media for information. ConclusionsThe study revealed generally positive perceptions of minimally invasive hemorrhoid surgery, with cost being a significant factor. Knowledge gaps exist, particularly among non-medical personnel. Future initiatives should aim to enhance public awareness of minimally invasive surgery benefits, and policy considerations should address financial aspects of healthcare decisions.

Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study

Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study

Long-term results and quality of life after stapled hemorrhoidopexy vs Doppler-guided HAL-RAR: a propensity score matching analysis.

The study aimed to evaluate and compare the short and long-term outcomes of doppler-guided (DG) hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) using a wireless-doppler-guided probe and stapled hemorrhoidopexy (SH) for treatment of II-III hemorrhoids. This cohort study included patients who underwent HAL-RAR (n = 89) or SH (n = 174) for grade II-III hemorrhoids between January 2020 and December 2021. After propensity score matching at a 1:1 ratio, 76 patients for each group were analyzed. Short and long-term outcomes were collected. Pain was measured using a Visual Analogue Scale (VAS) at POD1, POD 10, 1month, and 6months after surgery. The enrolled patients completed the Hemorrhoidal Disease Symptom Score and Short Health ScaleHDquality of life (HDSS/SHS QoL) questionnaire preoperatively and during a regular follow-up visit at 24months after surgery. Groups exhibited comparable overall postoperative complication rates (23% HAL-RAR/ 21% SH; p = 0.295). Postoperative pain via VAS showed median scores of 4, 3, 1, 1 for HAL-RAR and 6, 4, 2, 1 for SH at POD1, POD10, 1month, and 6months, respectively (p = < 0.001, 0.004, 0.025, 0.019). At a median follow-up of 12months, the recurrence rate was 10.5% in the HAL-RAR group and 9.2% in the SH group (p = 0.785), respectively. At 24months, 15.7% of HAL-RAR patients and 19.7% of SH patients remained symptomatic (p = 0.223). Median post-op QoL index was 1 (HAL-RAR) and 0.92 (SH), p = 0.036. HAL-RAR is a safe and feasible technique in treating grade II-III hemorrhoids showing better outcomes in terms of postoperative pain and QoL. This paper adds a new perspective in comparing the HAL-RAR and SH, focusing the attention on the patients and not surgical techniques. A long and difficult follow-up was completed to fully understand the long-term results and the impact on the QoL of the patients who underwent these procedures.

A comparative study between laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation and conventional (Milligan-Morgan) hemorrhoidectomy

Background: Hemorrhoids have a much higher incidence than rectum and colon diseases worldwide. The prevalence was estimated to be between 2.9% and 27.9% among the worldwide population, of which 4% are symptomatic. Based on the Gauss method, the highest incidence was present in patients aged between 45 and 65 years. Aims and Objectives: To compare laser hemorrhoidoplasty with digital-guided hemorrhoidal artery ligation (DGHAL) and conventional (Milligan-Morgan) open hemorrhoidectomy procedures. Materials and Methods: A prospective follow-up study was undertaken in the Department of Surgery, Maharani Laxmi Bai Medical College, Jhansi, from January 2020 to June 2021. In this comparative and prospective study, 60 patients were included, of whom 30 were treated with open surgical hemorrrhoidectomy (Milligan-Morgan) and 30 were treated with laser hemorrhoidoplasty with the DGHAL method. Results: Male patients numbered 41 and female patients numbered 19. Between laser hemorrhoidoplasty with DGHAL and the open surgical hemorrrhoidectomy (Milligan-Morgan) approach, there were significant differences in operating time, blood loss, bleeding; and early postoperative pain. In terms of early postoperative pain, there were statistically significant differences between the two groups (P&lt;0.001). The mean operational time for laser hemorrhoidoplasty with DGHAL was 22.57±1.794 min, compared to 29.43±3.664 min for the open surgical hemorrrhoidectomy (Milligan-Morgan) method (P&lt;0.002). Conclusion: Laser hemorrhoidoplasty with Doppler-guided hemorrhoidal artery ligation (DGHAL) is safe and effective in cases of all grades of hemorrhoids as compared to open surgical (Milligan-Morgan) hemorrhoidectomy.

Clinical efficacy of ultrasound doppler-guided hemorrhoidal artery ligation combined with procedure for prolapse and hemorrhoids in treatment of severe hemorrhoids.

Hemorrhoids are a prevalent anorectal condition that affects a wide range of adult populations. The severity of this condition was graded using a validated hemorrhoidal grading system, specifically focusing on grade III and IV cases. This retrospective study aimed to compare the clinical efficacy of a standard Procedure for Prolapse and Hemorrhoids (PPH) with a combined Doppler-guided Hemorrhoidal Artery Ligation (DG-HAL) and a PPH approach in patients with severe hemorrhoids. Conducted from May 2021 to January 2023, the study included patients aged 18-65 with confirmed diagnosis of Grade III or Grade IV hemorrhoids. Patients with a history of anorectal surgery and significant comorbidities were excluded. The control group underwent standard PPH, whereas the observation group received DG-HAL followed by PPH. Clinical outcomes were measured using variables such as the operative duration, intraoperative blood loss, postoperative wound healing time, and length of hospital stay. Efficacy was evaluated using a hierarchical scale and a visual analog scale (VAS) for postoperative pain. The complication rates were also assessed. baseline characteristics were homogeneous between the 2 groups. The observation group demonstrated significantly faster postoperative wound healing and shorter hospital stay (P < .01). The overall therapeutic efficacy in the observation group was 90.0%, which was higher than that of the control group (75.0%; P = .025). The VAS pain scores were also significantly lower in the observation group (P = .002). A marked decrease in complication rates was observed in the observation group (3.3%) compared with that in the control group (17.9%) (P < .05). The combined DG-HAL and PPH surgical approach exhibited superior clinical efficacy in treating severe hemorrhoids. This technique offers high effectiveness, reduced postoperative VAS pain scores, and lower complication rates. The long-term efficacy requires further observation.

Haemorrhoidal artery distribution in patients with grade III and IV haemorrhoids treated with artery ligation and rectoanal repair. Assessment of Doppler guidance

IntroductionWhile haemorrhoidal dearterialization and mucopexy are accepted as a valid alternative to haemorrhoidectomy, differences exist regarding the fixed or variable location of the arteries to be ligated. Our aim was to shed light on this issue of arterial distribution in candidates for surgery. MethodsThe study included consecutive patients diagnosed with Goligher grade III and IV haemorrhoids, who had undergone Doppler-guided haemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) at 2 medical centres in Spain. The main objective was to evaluate the number and 12-h clock locations of arterial ligatures necessary to achieve Doppler silence. ResultsIn total, 146 patients were included: 111 (76%) men, and 35 (24%) women. Average age was 54 years (21–84). Grade III and grade IV haemorrhoids were diagnosed in 106 (72.6%) and 40 (27.4%) patients, respectively. The average number of ligatures per patient was 7 (range 2–12).Ligature percentages greater than 60% occurred at clock positions 7, 11, 10, 12, 9, and 1. The average number of mucopexies per patient was 3 (range 1–4). The most frequent mucopexy locations were the left posterior, right posterior, and right anterior octants. ConclusionsWhile the greatest frequency of arterial ligatures occurred in odd-numbered clock positions, non-negligible percentages occurred in even-numbered clock positions, which, in our opinion, makes the use of Doppler necessary, given that arterial distribution is not the same in all patients. We also noted that more ligatures and mucopexies were needed on the right half of the rectal circumference than on the left side, suggesting greater right-side vascularization.

Doppler Guided Haemorrhoidal Artery Ligation in the Management of Symptomatic Hemorrhoids

Abstract Background Hemorrhoid ligation with mucopexy is a simple, safe and cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. It can be performed on an outpatient or day care basis on grade 3 and 4 hemorrhoids to control bleeding and prolapsing hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains. Objective To evaluate prospectively the outcome of Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Patients and Methods Types of studies: A prospective study. Study setting: The study conducted in Ain Shams University Hospital (El Demerdash) under supervision of these supervisors. Study period: Six months. Results It is easy for the surgeon to learn it and acquire appropriate skills after a short learning curve. The HAL is a minimally invasive technique that is conceptually painless for patients since all maneuvers and sutures are endoanal and above the dentate line; this helps an early recovery and allows an ambulatory procedure. We must bear in mind that postoperative pain is often the most common concern for patients and professionals dealing with hemorrhoids. The results of HAL in this study show a very low postoperative pain rate (two patients_ lower than 7%); moreover, it is easily controlled with oral analgesia. One patient (3%) complained of retention of urine, which controlled easily. Conclusion Hemorrhoid ligation with mucopexy is a simple, safe and cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. It can be performed on an outpatient or day care basis on all grades of hemorrhoids to control bleeding and prolapsing hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.

Evaluation of Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) as a Novel Technique in Management of Hemorrhoids

Evaluation of Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) as a Novel Technique in Management of Hemorrhoids

Prolapso hemorroidal circunferencial mixto. Tratamiento combinado con sutura mecánica y fotocoagulación con láser

Management of circumferential hemorrhoidal prolapse represents a challenge for surgeons. There are currently many alternatives to conventional procedures.; however, none of these techniques consider treatment of external disease. Even procedures associated with less postoperative pain as stapled hemorrhoidectomy or Doppler-guided hemorrhoidal artery ligation do not involve treatment of the external component. The aim of this publication is to present the technique detailed to treat patients with mixed hemorrhoidal prolapse, combining stapled hemorrhoidopexy with laser coagulation of external hemorrhoids. The results have been previously documented in a total of 25 patients, with 4% of complications. We conclude that the procedure is an option to consider in patients with circumferential hemorrhoidal prolapse with external component.

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

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. 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. 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. Simple mucopexy with blind HAL (without Doppler guide) might be considered for the treatment of grades 3 and 4 hemorrhoids effectively.

Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis.

Surgical treatment of hemorrhoidal disease (HD) in inflammatory bowel disease (IBD) has been considered to be potentially harmful, but the evidence for this is poor. Therefore, a systematic review of the literature was undertaken to reappraise the safety and effectiveness of surgical treatments in this special circumstance. A MEDLINE, Web of Science, Scopus, and Cochrane Library search was performed to retrieve studies reporting the outcomes of surgical treatment of HD in patients with Crohn’s disease (CD) and ulcerative colitis (UC). From a total of 2072 citations, 10 retrospective studies including 222 (range, 2–70) patients were identified. Of these, 119 (54%) had CD and 103 (46%) UC. Mean age was between 41 and 49 years (range 14–77). Most studies lacked information on the interval between surgery and the onset of complications. Operative treatments included open or closed hemorrhoidectomy (n = 156 patients (70%)), rubber band ligation (n = 39 (18%)), excision or incision of thrombosed hemorrhoid (n = 14 (6%)), and doppler-guided hemorrhoidal artery ligation (DG-HAL, n = 13 (6%)). In total, 23 patients developed a complication (pooled prevalence, 9%; (95%CI, 3–16%)), with a more than two-fold higher rate in patients with CD compared to UC (11% (5–16%) vs. 5% (0–13%), respectively). Despite the low quality evidence, surgical management of HD in IBD and particularly in CD patients who have failed nonoperative therapy should still be performed with caution and limited to inactive disease. Further studies should determine whether advantages in terms of safety and effectiveness with the use of non-excisional techniques (e.g., DG-HAL) can be obtained in this patient population.

Comparison of Post Operative Pain Score between Doppler-Guided Hemorrhoidal Artery Ligation and Recto Anal Repair with Open Hemorrhoidectomy on Internal Hemorrhoid Grade III-IV at Siloam Hospitals Lippo Village

&lt;div class="WordSection1"&gt;&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hemorrhoids are a common lesion affecting 5% of the general population. Open hemorrhoidectomy has been considered a gold standard. However, this method has a significant score of postoperative pain Because of this side effect, another alternative method to treat hemorrhoids has been invented which can reduce post-operative pain. One of these methods is doppler-guided hemorrhoidal artery ligation and rectoanal repair (DGHAL-RAR). This study aims to know the comparison of the postoperative pain score between doppler-guided hemorrhoidal artery ligation and rectoanal repair compared with open hemorrhoidectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method:&lt;/strong&gt; The sample population of this study is internal hemorrhoid grade III-IV patients at Siloam Hospitals Lippo Village from 2018-2020. Visual analog scale data are taken from medical records. Sample data is obtained using a consecutive sampling method until 64 samples are met. The data obtained will be processed with the Mann U-Whitney test.&lt;/p&gt;&lt;/div&gt;&lt;div class="WordSection2"&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; Incidence of postoperative pain more than VAS 3 occurred in DGHAL- RAR and open hemorrhoidectomy is 81,3% and 96,9% with a p-value of 0,104. The average score of Visual Analogue Scale score in DGHAL-RAR and open hemorrhoidectomy are 1,97 and 3,13 with a p-value of 0,001.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; This study shows that the comparison of pain scores in DGHAL-RAR and open hemorrhoidectomy is not statistically significant. The mean score of the Visual Analogue Scale Score in the DGHAL-RAR group is statistically significantly lower than the mean score in the open hemorrhoidectomy group.&lt;/p&gt;&lt;/div&gt;&lt;strong&gt;&lt;br clear="all" /&gt;&lt;/strong&gt;

Management of Hemorrhoids with Doppler-Guided Hemorrhoidal Artery Ligation

Abstract Background An innovative therapy for symptomatic hemorrhoids has been recently proposed it relies on the reduction of hemorrhoidal vascular flow by suturing hemorrhoidal arteries, which are previously located by means of an ultrasound transducer. Objective To evaluate retrospectively the outcome of Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Patients and Methods Aretrospective study. The study conducted in Ain Shams University Hosptial (El Demerdash) under supervision of these supervisors. Study period: Six months. Results In our series, the HAL technique has achieved complete control of symptoms in 93.3% of patients after six-monthes follow-up. Conclusion Hemorrhoid ligation with mucopexy is a simple, safe and cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. It can be performed on an outpatient or day care basis on all grades of hemorrhoids to control bleeding and prolapsing hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.

Doppler-guided hemorrhoidal artery ligation with suture mucopexy compared with LigaSure™-assisted pile excision for the treatment of grade III hemorrhoids: a prospective randomized controlled trial.

Doppler-guided hemorrhoid artery ligation and stapled hemorrhoidopexy have been used in surgical practices to avoid post-hemorrhoidectomy pain. Our study compared Doppler-guided hemorrhoid artery ligation with suture mucopexy (DGHAL-SM) and ligature-assisted pile excision (LAP) for greater than three grades of internal hemorrhoids. Eighty patients with greater than 3 grades of internal hemorrhoids were selected (age range: 20-28 years; average age: 23 years) between January and June 2015. The patients were randomly divided into group A (DGHAL-SM) and group B (LAP); each group had 40 patients. With respect to the postoperative cure rate and anal skin tags, group A was inferior to group B, but the postoperative pain assessment and satisfaction were better than group B (P<0.001). The DGHAL-SM cure rate was high; the postoperative pain was mild; 97.5% of the patients did not return to hospital because of pain. LAP has a higher cure rate than DGHAL-SM, but the postoperative pain and return rate within 6 h was as high as 65%, and the postoperative satisfaction assessment was lower than DGHAL-SM. Therefore, we recommend that DGHAL-SM for outpatient surgery in patients with greater than three grades of internal hemorrhoids.

Abstract No. 551 Is hemorrhoid artery embolization a viable treatment modality for internal hemorrhoids?

In the United States, 10 million people are affected by internal hemorrhoids each year, causing symptoms of painless bleeding, pruritis, mucous discharge, and fecal leakage. These were treated primarily by surgical resection until Morinaga et al. introduced the Doppler-guided hemorrhoidal artery ligation (DG-HAL) in 1995. This procedure utilizes a proctoscope with a Doppler flowmeter to simplify hemorrhoidal artery suture ligation, reduce post-operative pain, and eliminate the need for general anesthesia.

Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal Repair Outcome on Female Patients in Basra: Assessment Study

Background: Hemorrhoidal disease is a common morbidity seen by general surgery clinics. Transanal Doppler guided (DG) hemorrhoidal artery ligation (HAL) with rectoanal repair (RAR) has been invented as a new treatment option. HAL-RAR was associated with mild to moderate postoperative complications in the literatures; and considered easy, safe, mostly painless procedure with very good results in treating hemorrhoids. Objective: This study was conducted to evaluate the outcome of using DG-HAL-RAR procedure through documenting postoperative complications during a median follow-up period of 18 months. Method: The study included 151 women presented with hemorrhoids in Basra, operated upon using the DG-HALRAR and complications assessed. Results: The patients’ mean age was 40–99 years. Most of the hemorrhoids were internal plus external (86.1%), of third degree (68.2%) and non-recurrent (90.1%). The surgical management needed an average of 6 ligations and 3 mucopexies. During the follow up periods, the most frequent complication was early bleeding, while the least was hemorrhoids recurrence. Discussion: During the follow up period, the postoperative complications were early bleeding, early pain, urine retention, late bleeding, anal stenosis, and hemorrhoids recurrence, the incidence of which were similar or close to the incidence of documented by other studies, except for early bleeding which was much higher than in our study. Some complications, reported by other studies,were not reported in this study. Conclusions: DG-HAL-RAR procedure can be used effectively and safely in second or third degree hemorrhoids. Keywords: Hemorrhoidectomy, Anal surgery, DG-HAL-RAR, Basra

Hemorrhoidal Artery Ligation Operations-Recto-Anal Repair (HALO-RAR) Procedure for Recurrent Haemorrhoids: Excellent Patient Satisfaction.

BackgroundHaemorrhoid is the most common anal canal disease. Treatments may vary from non-invasive to invasive depending on the symptoms. Haemorrhoidectomy has been widely used. However, it has some drawbacks like severe postoperative pain, longer time to return to daily activities and complications such as anal stenosis. To overcome these, various new treatment methods have been introduced. Doppler-guided hemorrhoidal artery ligation operations (HALO) are becoming popular among surgeons. HALO has been reported to have a lower recurrence rate of less than 10% and higher patient satisfaction of approximately 90% with minimal postoperative pain. It achieves very good postoperative outcomes in the treatment of early haemorrhoids where per rectal bleeding and/or perianal discomfort are main symptoms. Nevertheless, it has a limitation in the treatment of prolapsing haemorrhoids. To tackle this, simultaneous recto-anal repair (RAR) has been recently introduced. HALO, in combination with RAR, has been reported to achieve good postoperative outcomes and excellent patient satisfaction.This is a two-stage open operation. The stages are: - Doppler-guided HALO and - RAR (recto-anal repair)MethodsWe are presenting a single-centre one-year experience of Doppler-guided haemorrhoidal artery ligation operation and recto-anal repair (DG-HALO and RAR) conducted on haemorrhoidal patients to evaluate the outcomes and effectiveness of the procedure. Retrospective data were collected for the patients who underwent HALO over one year period from June 2018 to August 2019. A total of 10 patients were treated with the HALO-RAR procedure.ResultsThe male to female ratio was 7:3, median age was 47.98 (28.38 - 61.7) years, median body mass index (BMI) was 30.23 (23.8 - 39.1). Eight patients were American Society of Anesthesiologists (ASA) Grade II, one patient was ASA I and one was ASA III. Time from initial consultation to the HALO procedure was 9.90 (3.5 - 19.8) months. All patients complained of preoperative bleeding and six of them complained of pain or discomfort. Nine patients underwent previous bandings in the clinic and one patient declined banding. The average time of the procedure was 57 mins. The average number of ligations was 10 (0-21). In one case, the proctoscope did not pair with the speaker. The average number of plications was three (2-4). Postoperatively, nine patients had no immediate complications; one patient had acute urinary retention. Seven patients were discharged on the same day. One patient had to stay overnight for monitoring prior to restarting apixaban, one patient for his learning difficulties and one patient had an unplanned overnight stay due to acute urinary retention requiring catheterization. Eight patients had their first follow-up; improvement of symptoms was found in 100% patients on the first follow-up.ConclusionHALO-RAR should be considered as a treatment option for recurrent symptoms after banding for haemorrhoids. The study showed good overall results with no immediate surgical complications. Excellent patient satisfaction was found even in long-term follow-up.

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

Several studies comparing Doppler-guided hemorrhoidal artery ligation (DG HAL) with or without mucopexy with hemorrhoidopexy and hemorrhoidectomy techniques show no difference in short-term efficacy. The aim of this study was to evaluate efficacy of DG HAL with mucopexy (DG HAL+m) in the long term (beyond 5years) for patients with hemorrhoidal disease. A retrospective observational study was conducted on patients with symptomatic hemorrhoidal disease of any stage treated with DG HAL m at our outpatient colorectal surgery unit in April 2009-April 2013. Patients were followed clinically for 1month and with a questionnaire until 5years after surgery or until they underwent a second surgery for recurrent hemorrhoids. Of 150 patients who underwent DG HALm during the study period 50 (33.3%) were lost to follow-up. A total of 100 patients (47 women, 53 men) were analysed. The average age was 50 (± 12) years. Twenty-six patients (17.3%) had had one or more prior procedures. The mean length of hospital stay was 2.2days (median = 2days; range = 1-8days). No major complications were described. There were no deaths. At 5years the mean bleeding, local discomfort and pain scores were significantly improved. Thirty-six patients (35.6%) had a recurrence during the follow-up period, and 20 (19.8%) of them underwent reoperation. The mean time between the operation and the second procedure was 36months (median 27.4months). The majority (61.4%) of patients were satisfied with the procedure. Despite the low invasiveness of DG HALm the low morbidity associated with the procedure and the satisfactory functional outcomes, the long-term recurrence rate can be very high. However, only about half of the patients who experienced a recurrence needed a second operation.

Assessment of haemorrhoidal artery network using Doppler-guided haemorrhoidal artery ligation for haemorrhoids and pathogenesis implications.

Some authors, either with anatomical studies or Doppler laser flowmetric investigations have shown the blood flow to the posterior midline of the anus to be potentially deficient. This relative local ischaemia might explain pathogenesis of anal fissure, which is often located posteriorly. The aim of this study was to record the exact position of the distal branches of the superior rectal artery during Doppler-guided haemorrhoidal artery ligation-rectoanal repair (HAL-RAR) procedures with special reference to posterior distribution of the arteries. All consecutive patients with symptomatic haemorrhoids who were treated with the HAL-RAR procedure between February 2008 and February 2014 in a single institution were included in the study. Number and position of Doppler-guided ligations were prospectively collected. Pearson's chi-squared test was used to compare artery locations. A total of 150 patients (75 women) with symptomatic haemorrhoids were included in the study. Median age was 53 years (range 23-83). A median of 10 ligations were placed per patient (range 3-18). A significantly lower number of cumulative arterial ligations was recorded in the posterior position (88 ligations overall, P = 0.025). The number of distal branches of the superior rectal artery that have been localized by the Doppler-guided HAL-RAR technique is lower at the posterior midline than in the other segments of the lower rectum. This is another evidence of the vascular deficiency at the posterior pole of the anal canal that might explain the pathogenesis of the anal fissure.

Which is better: stapler haemorrhoidopexy vs traditional excisional surgery?

Background: Haemorrhoids are tortuous dilated veins within the submucosa of anal canal. They are external, internal or internoexternal. External haemorrhoids cause pain. Internal haemorrhoids are characterised by painless bleeding or prolapse. Various treatment options are available- dietary modification, band ligation, sclerosant therapy, cryosurgery, traditional excisional surgery (Milligan/Ferguson), stapler haemorrhoidopexy, Doppler guided haemorrhoidal artery ligation (DGHAL), application of harmonicscalpel and ligasure.Methods: Adult patients (&gt;18 yrs) with grade II, III &amp; grade IV haemorrhoids are randomly allotted in equal numbers to receive either stapler haemorrhoidopexy or traditional excisional surgery from July 2017 to December 2018. Post-operative complications, pain (using visual analogue scale), recurrence rate and the need for further surgery with these procedures were analysed in this 1 and half year study period.Results: Patients who underwent stapler haemorrhoidopexy had better temporary quality of life, but patients who underwent traditional excisional surgery had lesser recurrence.Conclusions: Overall, traditional excisional surgery should be the choice when compared to stapler haemorrhoidopexy.