A comparison of surgical devices for grade II and III hemorrhoidal disease. Results from the LigaLongo Trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy

Background: Minimally invasive surgeries are currently advocated in hemorrhoidal disease for better patient satisfaction. The aim of our study is to assess the feasibility, efficacy and safety of a hybrid hemorrhoidal artery ligation under digital guidance with laser hemorrhoidoplasty (Hybrid HAL-LHP) in patients with grade II to III hemorrhoids.Methods: In a prospective clinical study, hybrid HAL-LHP was performed in 75 consecutive patients between May 2018 to February 2020 with grade II to III hemorrhoids. Hemorrhoidal artery ligation was done by digital palpation followed by laser hemorrhoidoplasty using a 1470 nm diode laser. Postoperative pain and bleeding, return to work, resolution of symptoms, recurrence and reoperation was assessed on a follow up upto 1 year.Results: Postoperative pain assessed on Visual analog score (VAS) was 2.82 on 3rd day, 1.28 on 7th day and till 14th day was extremely low. None of the patients had significant intraoperative or spontaneous postoperative bleeding. Most of the patients had some degree of post defecation bleeding till 7th to 14 days which resolved after 2 weeks. After a mean follow up of 16.6 months, we reported a suspected recurrence rate of 5.33%.Conclusions: Postoperative pain assessed on Visual analog score (VAS) was 2.82 on 3rd day, 1.28 on 7th day and till 14th day was extremely low. None of the patients had significant intraoperative or spontaneous postoperative bleeding. Most of the patients had some degree of post defecation bleeding till 7 to 14 days which resolved after 2 weeks. After a mean follow up of 16.6 months we reported a suspected recurrence rate of 5.33%.

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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 ◽

10.1100/2012/324040 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Piotr Walega ◽

Michal Romaniszyn ◽

Jakub Kenig ◽

Roman Herman ◽

Wojciech Nowak

Keyword(s):

Safety Assessment ◽

Mucosal Prolapse ◽

Hemorrhoidal Disease ◽

Functional Evaluation ◽

Artery Ligation ◽

Major Complications ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Invasive Method ◽

Grade Iii

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD).Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure.Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P<0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR.Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

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A Randomized Clinical Study to Compare the Outcome of Hemorrhoidal Artery Ligation (HAL) Procedure with and without Doppler Guidance in Grades I–III Hemorrhoidal Disease

Indian Journal of Surgery ◽

10.1007/s12262-020-02606-z ◽

2020 ◽

Author(s):

Arshad Ahmad ◽

Mohd Kalimuddin ◽

Abhinav Arun Sonkar ◽

Suresh Kumar ◽

Pankaj Kumar ◽

...

Keyword(s):

Clinical Study ◽

Hemorrhoidal Disease ◽

Artery Ligation ◽

Randomized Clinical Study ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery

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A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy

Journal of Visceral Surgery ◽

10.1016/j.jviscsurg.2014.03.009 ◽

2014 ◽

Vol 151 (4) ◽

pp. 257-262 ◽

Cited By ~ 13

Author(s):

A. Béliard ◽

F. Labbé ◽

D. de Faucal ◽

J.-M. Fabreguette ◽

P. Pouderoux ◽

...

Keyword(s):

Comparative Study ◽

Stapled Hemorrhoidopexy ◽

Artery Ligation ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery

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Outcome of stapled hemorrhoidopexy versus doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids

Techniques in Coloproctology ◽

10.1007/s10151-011-0699-z ◽

2011 ◽

Vol 15 (3) ◽

pp. 267-271 ◽

Cited By ~ 26

Author(s):

S. Avital ◽

R. Itah ◽

Y. Skornick ◽

R. Greenberg

Keyword(s):

Stapled Hemorrhoidopexy ◽

Artery Ligation ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Grade Iii

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Long-term Results of Hemorrhoidal Artery Ligation

The American Surgeon ◽

10.1177/000313481608200314 ◽

2016 ◽

Vol 82 (3) ◽

pp. 216-220

Author(s):

İbrahim Yilmaz ◽

Dursun ÖZgÜR Karakaş ◽

İlker SÜCÜLlÜ

Keyword(s):

Short Form ◽

Long Term Results ◽

Artery Ligation ◽

Superior Rectal Artery ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Grade Ii ◽

Visual Analogous Scale

Aim of this study is to assess the efficacy, safety, and long-term results of doppler-guided hemorrhoidal artery ligation procedure with a 7-year follow-up period for treatment of grade II and III degree hemorrhoidal diseases. The procedure was performed by a specially designed proctoscope to locate and ligate all terminal branches of superior rectal artery. Patients were followed up at postoperative 1st week and 3rd, 12th, and 24th months by physical examination and 7th year by phone questionnaire using Short Form-36. Between November 2006 and May 2007, 50 patients (29 females, mean age = 38.2) underwent this procedure. All patients discharged at operation day and mean return to work was 2.5 days. There were no major complications and mean postoperative Visual Analogous Scale at first week was 1.72. At 24th month, 44 (88%) and 38 (76%) patients at 7th year were symptom free. Doppler-guided hemorrhoidal artery ligation is a safe, effective, and outpatient procedure, which can be the treatment of choice for second- and third-degree hemorrhoidal diseases with satisfactory long-term results.

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