Hemorrhoidal Artery Ligation Research Articles

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.

P443 Haemorrhoidal Artery Ligation – Recto-Anal Repair (HAL-RAR) with mucopexy for grade III hemorrhoids in IBD patients

Abstract Background Symptomatic hemorrhoids represent an important and sometimes underestimate chapter of perianal Inflammatory Bowel Diseases (IBD), with an incidence reported up to 20.7%. At present, there is still no consensus in the scientific community on the exact indications of surgery in IBD patients presenting with symptomatic haemorrhoids, due to the reported high risk of postoperative complications. We describe our experience with Haemorrhoidal Artery Ligation – Recto-Anal Repair (HAL-RAR) hemorrhoidopexy in highly selected patients with IBD. Methods This was a single-center longitudinal study of a cohort of patients with both Ulcerative Colitis (UC) and Crohn’s Disease (CD) who underwent HAL-RAR using a dedicated doppler-guided probe (Trilogy™) for symptomatic grade III hemorrhoids not responding to medical therapy. Short and long-term postoperative morbidity were recorded. Severity of hemorrhoid symptoms, specifically bleeding, prolapse, manual reduction, discomfort or pain and impact on quality of life (Giordano score) and fecal continence status (Vaizey score) were evaluated before surgery and at minimum of 6 months after surgery. Results Sixteen patients with symptomatic grade III haemorrhoids underwent HAL-RAR (12 female). The mean age was 49 yrs old (37–66). Twelve had CD and 4 UC; none presented with anorectal or perianal involvement. All patients were taking optimal medical treatment for IBD. Only the patients with CDAI&amp;lt;150 and Full Mayo score of 1 (with endoscopic sub-score of 0) were included. Mean follow-up was 27.8 months (9–76). The mean operating time was 46 minutes. Short-term complications included one patient requiring prolonged analgesia with NSAIDs for two weeks, one patients needing hospitalization for bleeding after 10 days, treated conservatively and one patient with acute urinary retention, resolved after catheterization. The was no abscess or fistula formation. During the follow-up period, no patients suffered from recurrent haemorrhoidal bleeding and none had recurrent prolapse. A 66 yrs old female reported at 6 months post-operatively the worsening of Vaizey score from 4 to 6 due to the need of taking costipating medicines. All patients report significant amelioration of quality of life. Conclusion Our results show that HAL-RAR Hemorrhoidopexy is a safe and effective technique for treating grade III symptomatic hemorrhoids in highly selected IBD patients without anorectal involvement. These results need to be validated in large and multicenter trials.

Safety and effectiveness of hemorrhoidal artery ligation using the HAL-RAR technique for hemorrhoidal disease.

A wide variety of methods has been proposed for treating hemorrhoidal disease. The aim of the study is to assess the safety and effectiveness of hemorrhoidal artery ligation with rectoanal repair (HAL-RAR). Retrospective study from January 2010 to November 2019 of patients who underwent HAL-RAR for grade II, resistant to conservative treatment, and grades III and IV hemorrhoidal disease. Demographics, degree of disease, hospital stay, postoperative pain, complications, and recurrence were recorded. Patients were followed up at postoperative days 1 and 8 and at 1, 6, and 12 months. A total of 105 patients (60 men, 45 women) underwent HAL-RAR. Median age was 49 (range, 20-86) years. Two patients with hemorrhoidal thrombosis underwent emergent excision of the hemorrhoid. Median length of hospital stay was 2 (range, 1-13) days. Patients reported median visual analog scale pain score 3 (range, 1-5) on the 1st postoperative day. At 1 month, no patient reported pain, 84.76% of patients confirmed complete resolution of symptoms, while complication rate was 7.61%: 2 patients presented urinary retention, 3 dyschezia, 2 bleeding, and 1 hemorrhoidal necrosis. At 6 months, 2 patients presented mild symptoms and 7 recurrence. At 12 months, 92.4% of patients experienced complete resolution of symptoms, 2 patients intermittent bleeding, and 2 recurrence. Overall recurrence and re-intervention rate were 8.57% rate and 10.5%, respectively. HAL-RAR is a safe and effective minimal invasive operative technique related to a high percentage of success, low complication, and recurrence rates. Long-term follow-up is lacking and would better establish the results of this technique. Trial registration number NCT04778124 Date of registration 26/02/2021 "retrospectively registered".

Hemorrhoidal Artery Ligation, Laser Hemorrhoidoplasty, and LIS in a Case of Grade 3 Hemorrhoids and Chronic Anal Fissure

Hemorrhoidal Artery Ligation, Laser Hemorrhoidoplasty, and LIS in a Case of Grade 3 Hemorrhoids and Chronic Anal Fissure

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.

Artery ligation versus rubber band ligation for management of second and third degree haemorrhoids in rural Rajasthan

Haemorrhoids have been a commonplace surgical problem since ancient times and recent advances have entailed a multitude of methodologies that can be adopted for its management. The present study was designed to ascertain if two modalities of artery ligation and band ligation are comparatively equal or not in managing symptomatic grade II and III haemorrhoids in a rural populace in Rajasthan. The study comprised of 60 subjects who were randomly divided in two groups based on the procedure to be performed. The subjects were explained the study and its objective. The observations reported that there were more relapses in band ligation as compared to artery ligation. This led to the conclusion that despite its painful and traumatic methodology, haemorrhoid artery ligation still provides a better outcome.

Impact of Ambulatory Surgery for Hemorrhoidal Disease on Clinical Outcomes and Institutional Costs

Abstract Objective Transanal hemorrhoidal artery ligation with mucopexy (ligation anopexy [LA]) and open hemorrhoidectomy (OH) can both be performed under local anesthesia. The aim of the present study was to analyze the impact and the cost-effectiveness of performing these techniques in an ambulatory setting of an Italian academic center on the postoperative outcome. Methods A series of 122 consecutive patients with grades II and III hemorrhoidal disease undergoing ambulatory surgical treatment of hemorrhoids in 2015 to 2018 (group A) was compared with 122 patients operated at the same institution in the same period (group H) in a hospital setting.The primary outcome was the number of days required to return to work/daily activities. Secondary outcomes included postoperative pain and complications, cost-effectiveness, patient satisfaction, and recurrence at 12 months. In group A, all the procedures were performed under local anesthesia with early discharge. In group H, the procedures were performed under general or loco-regional anesthesia with hospital admission. Results The mean number of days required to return to work/daily activities was 8.4 ± 4.8 days in group A, compared with 12.5 ± 3 days in group H (p &lt; 0.001). The visual analog scale (VAS) pain score at 1 week, 2 and 3 weeks, and 1 month after surgery was lower for patients undergoing LA in the ambulatory setting (p &lt; 0.01). We observed more postoperative complications in hospitalized (12.5%) than in ambulatory patients (7.5%) (p &lt; 0.001). The total mean direct costs per patient were significantly lower in the ambulatory setting versus the hospital stay group (351.3 versus 1,746 euros). Conclusion Implementing ambulatory surgery for hemorrhoids is feasible, safe, and cost-effective.

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 without Doppler navigation in surgical treatment of hemorrhoidal disease

To compare the immediate and long-term results of surgical treatment of hemorrhoidal disease (GD) stage II-III using two methods of identification of hemorrhoidal arteries (HA) with their subsequent ligation and mucopexy. A prospective, randomized, controlled, single-center study was conducted to evaluate the effectiveness of HA ligation with and without Doppler navigation. The study included 120 patients: group A - Doppler-guided ligation (n=60) and group B - ligation without ultrasound (n=60). GD stage II was found in 27 patients of the group A and 30 patients of the group B (p=0.4). Mean number of ligated HA in the group A was 3.36, in the group B - 2.83 (p=0.062). Mean number of mucopexy was 3.2 and 3.5, respectively (p=0.8). Mean follow-up period was 8.3±2.1 and 8.1±1.9 months, respectively (p=0.96). Relapse of all preoperative symptoms was registered in 1 patient (1.6%) in the group A. Intermittent bleeding was observed in 5 (8.3%) and 3 (5%) patients, respectively (p=0.71). Periodic hemorrhoid prolapse (GP) occurred in 6 (10%) and 4 (6.6%) respondents, respectively (p=0.74). VAS score of pain syndrome after 2 months and later was 0 - 1 points (p=1.0). Most of patients in both groups (group A - 89%, group B - 94%; p=0.7) noted that surgery did not disrupt their usual lifestyle and relieved from symptoms of GD. There are no significant advantages of Doppler-guided HA ligation compared to palpation regarding incidence of hemorrhoid prolapse (p=0.74) and hemorrhoidal bleeding (p=0.71). Pain syndrome (p=0.24), incidence of postoperative complications (p=0.51) and relapses (p=0.31) showed comparable safety of both techniques.

Treatment Options for Chronic Hemorrhoids

The paper provides an overview of various treatment options for chronic hemorrhoids based on current national and international recommendations. The publication describes the basic principles of effective conservative therapy of the disease. Methods of minimally invasive treatment options for chronic hemorrhoids are given in details: sclerotherapy, infrared coagulation, latex ligation; advantages and disadvantages of each of these methods are highlighted. Literature data indicate that surgical removal of hemorrhoids remains an effective method of treatment for patients with hemorrhoids stage III IV, who underwent unsuccessful minimally invasive procedures. The characteristics of possible complications after hemorrhoidectomy and the frequency of their occurrence are also given. The authors analyze results of using stapler hemorrhoidopexy and the technique of Doppler-controlled ligation of hemorrhoidal arteries. Despite the variety of techniques, it remains relevant to search for further treatment options for chronic hemorrhoids in order to choose an effective individual treatment tactics for each patient, taking into account various manifestations of hemorrhoidal disease.

Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease: a non-inferiority randomized controlled trial

In this study, we proposed a combined outpatient treatment modality for hemorrhoidal disease. This study was a prospective non-inferiority randomized controlled trial (RCT). The experimental group included the dearterialization and hemorrhoidopexy under pudendal nerve block, whereas the comparator consisted of the standard Doppler guided hemorrhoidal artery ligation and hemorrhoidopexy, under spinal anesthesia. As primary hypothesis, we considered the non-inferiority of the proposed modality in terms of the presenting symptom remission rate (non-inferiority margin: 10%). Randomization was based on a 1:1 ratio. Blinding was confined to the patient and the investigator. Overall, 60 patients were enrolled. The primary hypothesis of this RCT (96.7% vs 73.3%) was validated. The experimental group was associated with a lower operation duration and an expedited onset of mobilization and feeding. Moreover, a favorable profile regarding short-term morbidity and analgesia was identified. The control group displayed a higher pile recurrence rate and a suboptimal patient satisfaction. A significant effect of the treatment modality in most of the SF-36 components was confirmed. The proposed treatment modality was associated with favorable short and long-term outcomes. Due to specific limitations, further RCTs, with a larger sample size, are required. Trial Registration ClinicalTrials.gov : NCT03298997.

A Randomized Clinical Study to Compare the Outcome of Hemorrhoidal Artery Ligation (HAL) Procedure with and without Doppler Guidance in Grades I–III Hemorrhoidal Disease

Hemorrhoidal artery ligation (HAL) procedure aims specifically at reducing the arterial flow to the hemorrhoids. The Doppler probe allows an accurate localization of the branches of superior rectal artery which are individually ligated. However, the vessels can also be ligated by digital palpation of vessels without the help of Doppler probe. In this study, we have compared the results of hemorrhoidal artery ligation procedure with and without Doppler guidance in symptomatic grades I–III hemorrhoids. The study was a single-blinded randomized clinical study. Patients were randomly allocated into two groups, the non-Doppler group (HAL group) and the Doppler group (DGHAL group). The outcome was assessed by using HDSS questionnaire as proposed by Nystrom et al. Patients were followed at 6 weeks, 6 months, and 1 year following the procedure. In this study, the overall control of bleeding was 86.9% (86.0% in HAL group and 87.9% in DGHAL group) after 1 year of follow-up. The overall recurrence of prolapse in patients with grade II hemorrhoids after 1 year of follow-up was 16.9% (17.9% patients in HAL group and 16.0% in DGHAL group). The overall recurrence of prolapse in patients with grade III hemorrhoid after 1 year follow-up was 58.6% (60% patients in HAL group and 57.1% in DGHAL group). However, there was no significant difference between both groups. No significant difference was found in both groups in the secondary outcome measures (pain, soiling, and itching). Our study indicates that the hemorrhoidal artery ligation procedure can be performed effectively without the use of Doppler transducer. The study also suggests that HAL procedure is more effective in early grade hemorrhoids (grades I and II).

Optimization of management of patients with coloproctological profile in outpatient surgical treatment of hemorrhoids

Objective. Various aspects of the organization and optimization of diagnosis and treatment, including surgical, in patients with hemorrhoids one of the most common diseases in coloproctology are still the subject of discussion. Problems of the postoperative period can be prolonged spasm of anal sphincter, severe pain syndrome and delayed postoperative bleeding.&#x0D; Materials and methods. We conducted a one-center prospective study in 214 patients, undergoing surgical treatment for stage 34 chronic hemorrhoids. The most common surgery for hemorrhoids was a different combination of hemorrhoidal artery ligation (HAL), rectomucopexy (RAR) and excision of one to three external hemorrhoids in one and the same patient. In all the observations, we used a specially developed questionnaire, including a visual-analog scale (VAS) and registration of taking anesthetiсs per day, so as to objectify the assessment of the level of pain after surgery. Identification of local inflammation included taking a blood sample in an amount of 0.1 ml when punctured with a GU insulin syringe during anoscopy and enzyme-linked immunosorbent assay in accordance with test system instructions and determining interleukin 1 (IL-1), interleukin 4 (IL-4), tumor necrosis factor (FNO-) and interleukin 8 (IL-8). Results. According to the results obtained (severity of pain syndrome and amount of anesthetics, absence of complications), patients were conditionally divided into three groups with mild reaction to surgery 44 (20.5 %), moderate 100 (46.5 %) and severe 70 (32.5 %). In the group with mild reaction, the level of the analyzed indices was almost consistent with the norm; in group II, there was an elevation of two of them; in group III, the level of at least three tests was higher than the norm.&#x0D; Conclusions. More favorably, the postoperative period proceeds against the background of initially unexpressed local inflammation. The proposed additional examination method, which allows identifying subclinical local inflammation and assessing its severity, should help to optimize the selection and, as a result, increase the efficiency and safety of surgical treatment of hemorrhoids on an outpatient basis.

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.

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English

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.

Experience with Haemorrhoidal artery ligation under direct vision at a tertiary care hospital: A case series.

This study aims to share the results of haemorrhoidal artery ligation under direct vision in the management of symptomatic haemorrhoids. We conducted a case series of 70 patients at Combined Military Hospital Rawalpindi & Quetta, from January 2015 to October 2017. All patients underwent Haemorrhoidal Artery Ligation (HAL) and Recto Anal Repair (RAR). Ligation of superior haemorrhoidal artery was done under direct vision following manual palpation. Patients were followed up postoperatively at 1, 3 and 6 months. At 1 month follow up, all 70 (100%) patients were pain free. Post operative bleeding was observed in 7 (10%) patients but did not require surgical intervention. Sixty two (89%) patients were able to return to their daily activities 1 week after surgery and 57 (81%) resumed military duties or joined their work place at 2 weeks. 70 (100%) patients were asymptomatic and 45 (64%) highly satisfied with their surgery at 3 months. This increased to 53 (75%) at 6 months. 48 (69%) said that they would recommend this procedure to someone else. Prolapse recurrence was observed in 1(1.42%) patient 6 months post operatively which was dealt by band ligation. All patients completed follow-up at 1, 3 and 6 months. HAL is a simple yet safe technique with few complications, acceptable patient satisfaction and early return to work.

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.

Ayurvedic and modern recent treatment modalities on hemorrhoids: a review article`

Ayurveda is an ancient science which protect health in healthy individuals and cures the condition in diseased population.Ayurveda is the science of life and Shalya Tantra is important branch, Which represent the surgical field. One of the prime important disease from Ashtamahagad is Arsha. Arsha is defined as a disease which torture patients vital force as enemy is called as Arsha. Arsha correlated with hemorrhoids described in modern science.(Haema-blood &amp; rhoos-flowing). In Ayurveda our Acharya described four type of treatment for Arsha, which is Bheshaj (conservative), Kshar, Agni, Shastra (surgery). In modern science hemorrhoids are defined as the protrusion of varicose vein from the rectal mucosal membrane in the rectal area which can grow to quit large size if not checked in time.it is one of the commonest diseas.Its incidence increases with advancing age. There are various kind of treatment Dietary Lifestyle modification,Tropical treatment, Oral medication, Parasurgical and Surgical treatment and modality is used to care. Sclerotherapy, Cryotherapy, Electriccoagulation, Infracoagulation, Radiofrequency coagulation &amp; excision, Dopplerlar guided hemorrhoidal artery ligation, Stapled hemorrhoidectomy,these are parasurgical procedures on hemorrhoids. Closed and Open hemorrhoidectomy, Harmonic scalpel and literature, Atomizer ward, these are surgical treatment on hemorrhoids. In this review article on attempt has been made to review the study carried out on Arsha.

Hemorrhoid artery ligation and recto-anal repair treatment for hemorrhoid: a case series

Introduction: Hemorrhoidal artery ligation (HAL) combined with recto-anal repair (RAR), is an alternative technique for the treatment of hemorrhoid disease from grade I to IV. HAL-RAR involves anoscope with a Doppler to identify the position and depth of rectal arterial, which can be selectively ligated 3-4 cm above the dentate line. This technique has been proposed as a practical, easy to learn, minimally invasive, and safe.Case: 5 cases in Husada Hospital Central of Jakarta with hemorrhoid grade IV underwent HAL-RAR. The initial result, 14th day post-operative follow up, early benefits, and postoperative complications that most affected by HAL-RAR technique will be analyzed. Treatment confirmed 5 cases showed less postoperative pain measured by visual analog scale (VAS), fewer complications, on the 14th day follow up the main complication there was only one case with residual protrusion in initial follow up resolved four weeks later, and well-controlled of manifestation. All patients were satisfied with the result.Conclusion: HAL-RAR is an easy to learn technique, useful to perform, less post-operative pain, and gives fewer complications as treatment of advanced hemorrhoid disease. But, needed more cases and a longer follows up to analyze the late complications and recurrence.