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Doppler‐guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III–IV haemorrhoids: a multicenter prospective study of safety and efficacy
Author(s) -
Theodoropoulos G. E.,
Sevrisarianos N.,
Papaconstantinou J.,
Panoussopoulos S. G.,
Dardamanis D.,
Stamopoulos P.,
Bramis K.,
Spiliotis J.,
Datsis A.,
Leandros E.
Publication year - 2010
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/j.1463-1318.2008.01739.x
Subject(s) - medicine , mucocutaneous zone , ligation , surgery , rectum , multicenter study , randomized controlled trial , disease
Objective The isolated use of Doppler‐guided haemorrhoidal artery ligation (DGHAL) may fail for advanced haemorrhoids (HR; grades III and IV). Suture haemorrhoidopexy (SHP) and mucopexy by rectoanal repair (RAR) result in haemorrhoidal lifting and fixation. A prospective evaluation was performed to evaluate the results of DGHAL combined with adjunctive procedures. Method The study included 147 patients with HR (male patients: 102; grade III: 95, grade IV: 52) presenting with bleeding (73%) and prolapse (62%). Results More ligations were required for grade IV than grade III HR (10.7 + 2.8 vs 8.6 + 2.2, P < 0.001). SHP (28 patients) and RAR (18 patients) at 1–4 positions were deemed necessary in 46 (31%) patients. Minimal (muco‐)cutaneous excision (MMCE) was added in 23 patients. SHP/RAR was applied more frequently in grade IV HR (60% vs 16%, P < 0.001). In patients not having MMCE, SHP/RAR was added in 57% of grade IV cases ( P < 0.001). Complications included residual prolapse (10; two second surgery), bleeding (15; two second DGHAL), thrombosis (four), fissure (three) and fistula (one). Analgesia was required not at all, up to 1–3 days, 4–7 days and >7 days by 30%, 31%, 16% and 14% of the patients, respectively. SHP/RAR was associated with greater discomfort (17% vs 6%, P < 0.001). No differences were found between SHP and RAR. At an average follow‐up of 15 months, 96% of patients were asymptomatic and 95% were satisfied. Conclusions DGHAL with the selective application of SHP/RAR is a safe and effective technique for advanced grade HR.