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



Abstract

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.

Keywords: hemorrhoids artery ligation recto-anal repair doppler

References

  1. Sabiston DC, Townsend CM. Sabiston textbook of surgery: The biological basis of modern surgical practice (20th ed). Philadelphia, PA: Elsevier Saunders; 2017
  2. Brunicarddi FC, Andersen DK, Timothy RD, Hunter JG, Schwartz SI. Schwartz’s principles of surgery (10th ed). New York: McGraw-Hill Education; 2014.
  3. Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. Journal of the American College of Surgeons. 2007;204(1):102-17.
  4. Margetis N. Pathophysiology of internal hemorrhoids. Annals of Gastroenterology. 2019;32(2):1-9.
  5. Mounsey AL, Halladay J, Sadiq TS. Hemorrhoids. American family physician. 2011;15;84(2):14-19.
  6. Agbo SP. Surgical management of hemorrhoids. Journal of Surgical Technique And Case Report. 2011;3(2):68.
  7. Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clinics in colon and rectal surgery. 2016;29(1):22-9.
  8. Chugh A, Singh RA. Agarwal PN. Management of hemorrhoids. Indian J Clinic Pract. 2014;25(6):577-80.
  9. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Diseases of the Colon & Rectum. 2018;61(3):284-92.
  10. Yamou R, Attolou G, Njoumi N, Alkandry S, Tahiri ME. The effectiveness of Doppler controlled hemorrhoidal artery ligation based on preliminaries results. Pan African Medical Journal. 2013;15(1):13-18.
  11. Scheyer M, Antonietti E, Rollinger G, Lancee S, Pokorny H. Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center. Techniques In Coloproctology. 2015;19(1):5-9.
  12. Chivate SD, Ladukar L, Ayyar M, Mahajan V, Kavathe S. Transanal Suture Rectopexy for Haemorrhoids: Chivate’s Painless Cure for Piles. Indian Journal of Surgery. 2012;74(5):412-7.
  13. Hoyuela C, Carvajal F, Juvany M, Tryoyamo D, Trias M. International Journal of Surgery. 2016;28:39-44
  14. Walega P, Romaniszyn M, Kenig J, Herman R, Nowak W. 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. The Scientific World Journal. 2012;13:18-22.
  15. Rotta CM, Moraes FO, Neto V, Fernandez A, Rotta TC, Gregório JV, Jacomo AL, Martinez CA. Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases. Journal of Coloproctology (Rio de Janeiro). 2012;32(4):372-84.
  16. Brown SR, Tiernan JP, Watson AJ, Biggs K, Shephard N, Wailoo AJ, Bradburn M, Alshreef A, Hind D, HubBLe Study team. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. The Lancet. 2016;23;388(10042):356-64.
  17. Zagryadskiy E, Goreloc SI. Transanal doppler-guided hemorrhoidal artery ligation and recto anal repair vs closed hemorrhoidectomy for treatment of grade III-IV hemorrhoids. a randomized trial. Pelviperineology. 2011;30:107-2.
  18. Jeong WJ, Cho SW, Noh KT, Chung SS. One year follow-up result of Doppler-guided hemorrhoidal artery ligation and recto-anal repair in 97 consecutive patients. Journal of the Korean Society of Coloproctology. 2011;27(6):298-02.

How to Cite

Pusparani, C. A., & Purnomo, S. (2019). Hemorrhoid artery ligation and recto-anal repair treatment for hemorrhoid: a case series. Bali Medical Journal, 8(3), S550-S552. https://doi.org/10.15562/bmj.v8i3.1550
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Christinawati Angelita Pusparani
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BMJ Journal

Sugiharto Purnomo
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