Doppler-guided Hemorrhoid Artery Ligation Research Articles

SURGICAL TREATMENT OF CHRONIC HEMORRHOIDS (LITERATURE REVIEW)

Summary. An analysis of clinical guidelines and literary articles on the treatment of patients with chronic hemorrhoids was carried out. Clinical recommendations do not differ in different countries regarding the approaches in terms of choosing options for conservative or operative therapy and methods of surgical treatment. Changing the diet, which allows you to eliminate constipation, normalize intestinal motility and obtain soft and voluminous stools, is an important stage of treatment. Pharmacological therapy has a low evidence base. Studies on the effectiveness of flavonoids for the treatment of chronic hemorrhoids are very heterogeneous, which does not allow for unequivocal conclusions. Rubber band ligation is the most effective procedure for the rapid elimination of chronic hemorrhoid symptoms, but it cannot effectively eliminate hemorrhoidal prolapse. Injection sclerotherapy has severe specific complications, which is why it is predicted to decrease in frequency for the treatment of chronic hemorrhoids. The only surgical approaches that experts recommend are open and closed hemorrhoidectomy. Stapler hemorrhoidopexy has a high frequency of specific complications, so it is necessary to approach its choice for the treatment of chronic hemorrhoids with caution. Doppler-guided hemorrhoid artery ligation is a physiological method of treatment, but it has a very high cost and is not economically viable. Conclusions. In patients with chronic hemorrhoids Goligher-1, Goligher-2, and in some cases - Goligher-3, “office procedures” can be chosen, but the patient should be informed about questionable results in the remote period. The operation of choice for patients with chronic Goligher-3 and Goligher-4 hemorrhoids remains open hemorrhoidectomy, the current modifications of which mainly include various technological approaches to cutting out nodes. Techniques in which a slightly different principle was proposed can be used as an alternative approach due to worse results when observing in distant terms.

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.

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

SURGICAL TREATMENT OF HEMORRHOIDAL BLEEDING IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDER ANTICOAGULANT AND ANTIPLATELET THERAPY

The OBJECTIVE was to build an algorithm for medical and surgical treatment of hemorrhoidal bleedings in patients with cardiovascular diseases under anticoagulant and antiplatelet therapy.MATERIAL AND METHODS. The research was based on the analysis of results of treatment of hemorrhoidal bleedings in 86 patients with comorbidity (chronic combined hemorrhoids (2–4 stages) and cardiovascular diseases) under antiplatelet and antithrombotic therapy. Doppler-guided hemorrhoid artery ligation (with or without recto-anal repair) was used for the patients from the study group with no interrupting regular antiplatelet and anticoagulant therapy, whereas, in control group of patients, antithrombotic therapy was rejected for three to seven days in order to implementation of hemorrhoidectomy by Milligan – Morgan.RESULTS. The doppler-guided hemorrhoid artery ligation with recto-anal repair was a minimally invasive method without intra-operative blood loss with lowest pain syndrome at the short in hospital staying in comparison to hemorrhoidectomy by Milligan – Morgan. This fact determined the great clinical and economic effectiveness of the research method for the treatment of hemorrhoidal bleedings in patients with comorbidity.CONCLUSION. The minimal invasive surgical method of treatment hemorrhoidal bleedings – doppler-guided hemorrhoid artery ligation – could be used for patients with cardiovascular diseases and did not require interrupting anticoagulant and antiplatelet therapy.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Comparison of Doppler Guided Hemorrhoid Artery Ligation and Milligan Morgan Hemorrhoidectomy in Management of Hemorrhoidal Disease

Background: Hemorrhoidal disease is the most common rectal disorder, and many modalities have been suggested for its treatment. Objectives: In this study, we compared Doppler-guided Hemorrhoid Artery Ligation, one of the newest techniques in the treatment of this disease, to the Milligan-Morgan Hemorrhoidectomy (open Hemorrhoidectomy). Patients and Methods: One hundred patients were enrolled in this study and divided randomly into two groups of fifty patients. Each group either underwent the Milligan-Morgan procedure or the Doppler-guided Hemorrhoid Artery Ligation method. The outcomes were compared using statistical methods. Results: Patient demographic results and symptomatology and the type of anesthesia used had no influence on the study results. The mean duration of the operation had no statistical difference. The major impact of this new method had less postoperative pain and more patient satisfaction. After a mean follow up of eighteen months, we had two cases of recurrence in the Doppler-guided Hemorrhoid Artery Ligation group with grade IV hemorrhoidal disease. Conclusions: Doppler-guided Hemorrhoid Artery Ligation is a safe and easy method for treating hemorrhoidal disease, but its results should be interpreted carefully, especially in grade IV of the disease.

Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases

The treatment of hemorrhoidal disease (HD) by conventional hemorrhoidectomy is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. Doppler-guided hemorrhoid artery ligation (DGHAL) is a minimal-invasive surgical treatment for HD that has been used as an alternative method in order to reduce these inconveniences. OBJECTIVE: To analyze the initial results of the DGHAL technique associated with rectal mucopexy in the treatment of HD. METHODS:Forty-two patients with stage I, III and IV hemorrhoids who were submitted to DGHAL were analyzed from December 2010 to August 2011. Eleven patients (26%) were stage II; 21 (50%), stage III; and 10 (24%), stage IV HD. All patients were operated by the same surgeon under spinal anesthesia and using the same equipment and technique to perform the procedure. The 42 patients underwent ligation of six arterial branches followed by rectal mucopexia by uninterrupted suture. Nine patients needed concomitant removal of perianal skin tag. In the postoperative, the following parameters were evaluated: pain, tenesmus, bleeding, itching, prolapse, mucus discharge and recurrence. The mean postoperative follow-up lasted four months (one to nine months). RESULTS: Tenesmus was the most common postoperative complaint for 85.7% of patients followed by pain, in 28.6%, perianal burning, in 12.3%, mucus discharge and perianal hematoma in 4.7%. Two patients had severe postoperative bleeding and required surgical haemostasis, one of which needed blood transfusion. Ninety-five percent of the patients declared to be satisfied with the method. CONCLUSION: Even though DGHAL has complications similar to those of other surgical methods, its results present less postoperative pain, allowing faster recovery and return to work. Studies with more cases and a longer follow-up are still necessary to assess the late recurrence.

Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal-Repair Modification: Functional Evaluation and Safety Assessment of a New Minimally Invasive Method of Treatment of Advanced Hemorrhoidal Disease

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD). Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure. Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P < 0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR. Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

Outcomes of Doppler-guided hemorrhoid artery ligation: analysis of 90 consecutive patients

Doppler-guided hemorrhoid artery ligation is a minimal-invasive surgical treatment option for hemorrhoidal disease. The aim of our study was to evaluate the early and long-term results of the procedure 1 year after the operation. In a period of 4 years, 90 patients were included in this study. The Doppler-guided hemorrhoid artery ligation was performed under either spinal anesthesia or local perianal block. We recorded the length of postoperative inpatient care, on-demand analgesics administered apart from the standard analgesic protocol, short- and long-term complications, and, finally, recurrences. The mean age of patients was 46 ± 12.6 years. The operation was performed under spinal anesthesia in 82 patients and under local perianal block in 8 patients. The mean operative time was 26 ± 4.1 min. On-demand analgesics administration was reported in sixteen patients (17.7%) the first postoperative day and in four patients (4.4%) the second postoperative day. A total of 58 patients (64.4%) were discharged from the hospital the day of the operation, 29 (32.2%) patients stayed overnight, and in three (3.3%) patients, a hospitalization period of 2 days was needed. Four patients (4.4%), two with grade III and two with grade IV hemorrhoids, developed early postoperative complications. Late complications were observed in three patients (3.3%). Recurrences, manifested either as bleeding or as prolapsing piles, were observed in six patients (6.6%), two patients with initial grade III and four with grade IV hemorrhoids. Doppler-guided hemorrhoid artery ligation seems to be a safe and effective treatment option for all grades of hemorrhoidal disease. Further prospective randomized comparative studies are needed in order to fully evaluate the true role of DG-HAL in the surgical armamentarium.

Doppler-Guided Hemorrhoid Artery Ligation Reduces the Need for Conventional Hemorrhoid Surgery in Patients who Fail Rubber Band Ligation Treatment

This study was designed to assess whether Doppler-guided hemorrhoid artery ligation can prevent patients from needing conventional surgery when rubber band ligation of their hemorrhoids has failed to achieve symptomatic relief. All patients who underwent treatment for hemorrhoids in two hospitals between September 2004 and June 2007 are reported. A total of 203 patients (121 women; mean age, 44 (range, 17-84) years) were treated by rubber band ligation for two (181 patients) or three hemorrhoids (22 patients) during the study period. Fifty-four of these patients (27 percent) continued to suffer symptoms of bleeding (38 patients) or bleeding and prolapse (16 patients) after three clinic assessments. Fifty-two of these 54 patients subsequently underwent Doppler-guided hemorrhoid artery ligation. Two other patients had stapled anopexy. After a median follow-up of 18 (range, 6-33) months, 12 of the 52 patients (23 percent) who underwent Doppler-guided hemorrhoid artery ligation have returned with recurrent symptoms of bleeding (6 patients) and/or prolapse (6 patients). Four patients with recurrent symptoms were treated by single quadrant hemorrhoidectomy, and the remaining eight underwent Doppler-guided hemorrhoid artery ligation with rectoanal repair. Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery where rubber band ligation has been unsuccessful.