HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up

Hoyuela, Carlos; Carvajal, Fernando; Juvany, Montserrat; Troyano, Daniel; Trias, M.; Martrat, Antoni; Ardid, Jordi; Obiols, J

doi:10.1016/j.ijsu.2016.02.030

Cited by 39 publications

(29 citation statements)

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“…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%

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: 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

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“…Ratto et al [12] showed an absence of important complications, which are represented mainly by anal tenesmus (13% of cases). Hoyuela et al [13] reported a 2-year prospective study and concluded that THD is a safe and almost painless technique that offers very good results in the control of hemorrhoidal symptoms. Infantino et al [14] reported similar results to this multicentric prospective trial.…”

Section: Discussionmentioning

confidence: 99%

Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients

2019

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Purpose Despite the minimally invasive nature of transanal hemorrhoidal dearterialization (THD) with Doppler arterial identification procedures, hemorrhoidectomy is still considered the gold standard procedure for hemorrhoidal disease. However, the classical techniques of hemorrhoidectomy have a high rate of postoperative complications. The main purpose of this study is to demonstrate the efficacy and complications of these techniques used for grades II and III hemorrhoids. Methods A retrospective (case-control) study was carried out from January 2009 to May 2014, and all patients undergoing surgical procedures for hemorrhoidal disease in two French clinics were considered. Application of inclusion and exclusion criteria identified 270 eligible patients (163 undergoing Doppler THD and 107 treated with Milligan Morgan hemorrhoidectomy). Statistical analysis was calculated considering immediate postoperative complications, functional results, chronic complications, and recurrences. Results Analysis of primary outcomes showed a significant difference between the 2 groups concerning postoperative pain, which had a lower rate in THD (P = 0.0001) and in postoperative bleeding (P = 0.02) than hemorrhoidectomy. However, long-term follow-up at three years showed a superior rate of recurrence in the THD group (P = 0.009). Conclusion The THD technique is a safe and effective procedure for grades II and III hemorrhoids, has lower rates of post-operative pain and bleeding, and allows faster hospital discharge; however, it also shows a higher rate of recurrence at three years of follow-up.

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“…3 HAL results have been improved when associated with fixation of prolapsed tissue with mucopexy or recto-anal repair (RAR). [4][5][6][7][8][9][10][11][12][13][14][15] As previously stated, the primary aim of this study is to compare the postoperative pain of HAL-RAR with EH, and the secondary outcomes are the following: symptom resolution rates, postoperative morbidity, early recurrence, and changes in quality of life.…”

Section: Introductionmentioning

confidence: 99%

Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life

et al. 2019

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Purpose. To compare outcomes of hemorrhoid artery ligation with recto-anal repair (HAL-RAR) and excisional hemorrhoidectomy (EH). The primary objective was to compare postoperative pain, and the secondary objectives were the following: symptom resolution rates, postoperative morbidity, recurrence, and changes in quality of life. Method. Prospective randomized controlled trial, including 40 patients with grades III-IV hemorrhoids who were allocated 1:1 to HAL-RAR and EH. Follow-up evaluation was performed at 15 days, 30 days, 6 months, 12 months, and then annually. Pain was measured using a Visual Analogic Scale and was self-recorded by patients. Quality of life was measured with Short Form Survey-36 questionnaire. Results. Postoperative pain was lower in the HAL-RAR group during the first 30 postoperative days. Moreover, from day 7 onward more patients in the HAL-RAR group reported complete absence of pain (Visual Analogic Scale score = 0). Globally, symptom resolution was significantly higher (P = .03) in the HAL-RAR group at day 15. Bleeding resolution was observed earlier in the HAL-RAR group than in the EH group (P = .04), but no differences in the resolution of prolapse, itching, and soiling were observed during the 30-day follow-up. After a mean follow-up of 15 months (range 12-27 months), no differences in postoperative morbidity and no recurrences were observed. An improvement was observed in all sections evaluated by the Short Form Survey-36 questionnaire with both techniques. Conclusion. HAL-RAR provokes less postoperative pain during a shorter period than EH and achieves resolution of hemorrhoidal symptoms with less postoperative complaints. No differences in morbidity and recurrence rate were observed after 12 months of follow-up.

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HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up

Abstract: HAL-RAR is safe and almost painless technique and it has very good results in the control of haemorrhoidal symptoms. This procedure should be considered as an effective first treatment option for haemorrhoids.

Cited by 39 publications

References 20 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

Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients

Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life

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