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

다국어 초록 (Multilingual Abstract)

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

참고문헌 (Reference)

1 Lucarelli P, "Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy : a randomised trial with long-term follow-up" 95 : 246-251, 2013

2 Dal Monte PP, "Transanal haemorrhoidal dearterialisation : nonexcisional surgery for the treatment of haemorrhoidal disease" 11 : 333-339, 2007

3 Zagriadskiĭ EA, "Transanal Doppler-guided desarterization with mucopexy(HAL-RAR)for the treatment of hemorrhoids stage III-IV" (4) : 59-64, 2013

4 Greenspon J, "Thrombosed external hemorrhoids : outcome after conservative or surgical management" 47 : 1493-1498, 2004

5 Riss S, "The prevalence of hemorrhoids in adults" 27 : 215-220, 2012

6 Ganz RA, "The evaluation and treatment of hemorrhoids : a guide for the gastroenterologist" 11 : 593-603, 2013

7 Guttenplan M, "The evaluation and office management of hemorrhoids for the gastroenterologist" 19 : 30-, 2017

8 Abudeeb H, "THD and mucopexy : efficacy and controversy" 21 : 89-92, 2017

9 Trenti L, "Short-term outcomes of transanal hemorrhoidal dearterialization with mucopexy versus vessel-sealing device hemorrhoidectomy for grade III to IV hemorrhoids : a prospective randomized multicenter trial" 62 : 988-996, 2019

10 Cataldo P, "Practice parameters for the management of hemorrhoids(revised)" 48 : 189-194, 2005

11 Rivadeneira DE, "Practice parameters for the management of hemorrhoids(revised 2010)" 54 : 1059-1064, 2011

12 Bouchard D, "One-year outcome of haemorrhoidectomy : a prospective multicentre French study" 15 : 719-726, 2013

13 Perivoliotis K, "Non-Doppler hemorrhoidal artery ligation and hemorrhoidopexy combined with pudendal nerve block for the treatment of hemorrhoidal disease : a non-inferiority randomized controlled trial" 36 : 353-363, 2021

14 Galkin EV, "Interventional radiology of chronic hemorrhoids" (4) : 52-56, 1994

15 Lohsiriwat V, "Hemorrhoids : from basic pathophysiology to clinical management" 18 : 2009-2017, 2012

16 Loder PB, "Haemorrhoids : pathology, pathophysiology and aetiology" 81 : 946-954, 1994

17 Gould D, "Examining the validity of pressure ulcer risk assessment scales : developing and using illustrated patient simulations to collect the data" 10 : 697-706, 2001

18 Faucheron JL, "Doppler-guided hemorrhoidal artery ligation and rectoanal repair(HAL-RAR)for the treatment of grade IV hemorrhoids : long-term results in 100 consecutive patients" 54 : 226-231, 2011

19 Aigner F, "Doppler-guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of grade III haemorrhoids : a prospective randomized controlled trial" 18 : 710-716, 2016

20 Forrest NP, "Doppler-guided haemorrhoidal artery ligation with recto anal repair : a new technique for the treatment of symptomatic haemorrhoids" 25 : 1251-1256, 2010

21 Walega P, "Doppler guided haemorrhoidal arterial ligation with recto-anal-repair(RAR)for the treatment of advanced haemorrhoidal disease" 12 (12): e326-9, 2010

22 Sneider EB, "Diagnosis and management of symptomatic hemorrhoids" 90 : 17-32, 2010

23 Gallo G, "Consensus statement of the Italian Society of Colorectal Surgery(SICCR) : management and treatment of hemorrhoidal disease" 24 : 145-164, 2020

24 Tsang YP, "Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease : a retrospective study and literature review" 18 : 1017-1022, 2014

25 Thomson JP, "Coloproctology and the pelvic floor" Butterworth-Heinemann 373-393, 1992

26 Picchio M, "Clinical outcome following hemorrhoid surgery : a narrative review" 77 (77): 1301-1307, 2015

27 Zhai M, "A randomized controlled trial comparing suture-fixation mucopexy and Doppler-guided hemorrhoidal artery ligation in patients with grade III hemorrhoids" 2016 : 8143703-, 2016

28 Béliard A, "A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy" 151 : 257-262, 2014

29 Morinaga K, "A novel therapy for internal hemorrhoids : ligation of the hemorrhoidal artery with a newly devised instrument(Moricorn)in conjunction with a Doppler flowmeter" 90 : 610-613, 1995

30 Talley NJ, "A gap in our understanding : chronic constipation and its comorbid conditions" 7 : 9-19, 2009