Doppler‐guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of Grade <scp>III</scp> haemorrhoids: a prospective randomized controlled trial

Aigner, Felix; Kronberger, Irmgard; Oberwalder, Michael; Loizides, Alexander; Ulmer, Hanno; Grüber, L.; Pratschke, Johann; Peer, Siegfried; Gruber, Hannes

doi:10.1111/codi.13280

Cited by 43 publications

(30 citation statements)

References 14 publications

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“…Recently, two RCTs compared the minimally invasive treatment options Doppler-guided hemorrhoidal artery ligation (DG-HAL) combined with a suture mucopexy versus a suture mucopexy alone. They showed low recurrence rates of 2–10% after 12–24 months follow-up for the suture mucopexy group [ 12 , 13 , 33 ]. However, long-term results of the suture mucopexy are limited: only one RCT fulfilled a follow-up of 2 years [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…Over the past two decades, knowledge of the anatomy of hemorrhoids has improved, leading to the introduction of new surgical technologies. This was accompanied by many studies comparing several surgical treatments including the Doppler-guided hemorrhoidal artery ligation (DG-HAL) with or without recto-anal repair (RAR) [ 9 – 11 ], a sutured hemorrhoidopexy [ 12 , 13 ], the stapled hemorrhoidopexy (SH) [ 14 – 16 ], and the traditional hemorrhoidectomy [ 17 – 20 ].…”

Section: Introductionmentioning

confidence: 99%

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A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

Tol

Bruijnen

Melenhorst

et al. 2018

Int J Colorectal Dis

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PurposeIn this study, we describe current practices in the management of hemorrhoidal disease in the Netherlands.MethodsA validated online survey was performed among Dutch surgeons and residents treating hemorrhoidal disease. Contact details were retrieved from the Dutch Association for Surgery resulting in 619 contacts. Only doctors who were treating hemorrhoidal disease regularly were asked to complete the questionnaire. The following items were assessed: initial treatment, recurrence, complications, and follow-up.ResultsIn total, 133 respondents completed the survey. Ninety percent of the respondents started with rubber band ligation (RBL) as the first treatment in low-grade hemorrhoidal disease. In case of recurrence, 64% of the respondents repeated RBL three times before switching to a more invasive treatment modality. In grade III hemorrhoidal disease, the respondents preferred more invasive techniques: a sutured hemorrhoidopexy was performed in 24%, Doppler-guided hemorrhoidal artery ligation (DG-HAL) in 9%, stapled hemorrhoidopexy in 19%, and the traditional hemorrhoidectomy in 31% of the patients, respectively. The majority of the respondents (39%) reported a mild complication in 5–10% of the patients. The most reported complication was pain. Nearly all the respondents (98%) reported a major complication in less than 5% of the patients. The majority of the patients (57%) were seen in outpatient clinics 6 weeks post-treatment.ConclusionThis Dutch survey showed areas of common practice for primary treatment of hemorrhoidal disease. However, it also demonstrated varying practices regarding recurrent hemorrhoidal disease. Practical guidelines are required to support colorectal surgeons in the Netherlands.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

Tol

Bruijnen

Melenhorst

et al. 2018

Int J Colorectal Dis

View full text Add to dashboard Cite

show abstract

“…Doppler-guided hemorrhoidal artery ligation was compared with sutured hemorrhoidopexy, or mucopexy, alone in three randomized controlled trials [8][9][10], with all the trials showing no benefit of the Doppler use in controlling hemorrhoidal symptoms. Sutured hemorrhoidopexy without the use of Doppler (sometimes called sutured mucopexy) could be an inexpensive, minimally invasive alternative treatment for hemorrhoids.…”

Section: Introductionmentioning

confidence: 99%

Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy

Poškus

Danys

Makūnaitė

et al. 2020

Int J Colorectal Dis

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Purpose To compare the results of laser hemorrhoidoplasty (LHP), excisional hemorrhoidectomy (EH), and sutured mucopexy (MP). Methods A randomized, parallel-group, double-blinded, single-center prospective study. Patients Symptomatic 2nd-or 3rd-degree hemorrhoids patients. Interventions Computer randomization sequence, patient blinding, operating surgeon blinding, and surgeon-evaluator blinding. LHP was performed using a 1470 nm diode laser. Up to 250 J of energy delivered per 1 hemorrhoid. The procedure was performed circumferentially. MP ligations were placed in the area of visible hemorrhoidal tissue. Standard EH was performed up to the level of the hemorrhoidal pedicle. Follow-up at 1 and 6 weeks and 1 year. Outcome measures Recurrence of symptoms requiring treatment, intensity, and duration of pain after the operation, patients' quality of life, fecal incontinence, and patients' evaluation of treatment. Results A total of 121 patients. Groups were even preoperatively. LHP took 15 min (SD 5.6), MP took 16 min (SD 5.58), and EH took 29 min (SD 10.3). Recurrence requiring treatment rate was 0% after EH, 10% after LHP, and 22% after MP, p = 0.004. LHP and MP were less painful than EH, p < 0.001. Patients after LHP returned to regular activity after 15 days, after MP after 22 days, and after EH after 30 days, p < 0.001. SF-36 scores were better after EH. Symptoms of fecal incontinence improved in all the groups. Patients evaluate LHP better than EH and MP. Limitations Single-center study. Conclusions Laser hemorrhoidoplasty is a safe, minimally invasive option for hemorrhoids, more effective than MP and less effective than EH. Patients evaluate this technique better than the other two.

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“…The authors report that non DG-HAL techniques have gained in popularity which make the procedure less costly. Abandoning the Doppler proctoscope which had a questionable benefi t for the success of this technique was already demonstrated by our own group and others [3].…”

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confidence: 93%

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2018

Colorectal Disease

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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

Abstract: Mucopexy techniques for treating prolapsing haemorrhoids are effective, but DG-HAL does not add significantly to the results achieved by mucopexy. Repositioning the haemorrhoidal zone is the key to success, and mucopexy should be placed at the sites of the largest visible prolapse.

Cited by 43 publications

References 14 publications

A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

A national evaluation of the management practices of hemorrhoidal disease in the Netherlands

Results of the double-blind randomized controlled trial comparing laser hemorrhoidoplasty with sutured mucopexy and excisional hemorrhoidectomy

Issue Information ‐ TOC

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