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

Abstract

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.

Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease

“…22 The SHeLF technique was conceived based on the therapeutic proposal of the DGHD þ M technique, also interrupting blood flow by applying transfixing points on the arterial branches and subsequent fixation of hemorrhoidal cushions prolapsed, but in a higher situation when compared to the classical procedure. 1 Another difference in relation to the standardized technique of DGHD þ M is that the application of the point for ligation in the arterial branch identified by doppler and mucopexy is only performed in the cushions of the patient. In these cushions, mucopexy is in a higher position (farther from the pectin line).…”

“…This technique is a noninvasive surgical option, as it is not excisional, and has been used to treat the various degrees of HD. 1,12 In the DGHD þ M technique, six arterial branches identified by Doppler are dearterialized throughout the circumference of the mucosa of the distal rehest, and mucopexy is performed by means of a manual suture that begins in the highest portion of the cushion and ends just above the pectinline line. 1,12 The ligation of six arterial branches made the surgery more laborious.…”

“…1,12 In the DGHD þ M technique, six arterial branches identified by Doppler are dearterialized throughout the circumference of the mucosa of the distal rehest, and mucopexy is performed by means of a manual suture that begins in the highest portion of the cushion and ends just above the pectinline line. 1,12 The ligation of six arterial branches made the surgery more laborious. With this, in many cases, dearterialization was performed in a place where, although a prolapsed hemorrhoidal cushion was not identified, it was possible to identify arterial blood flow.…”