A Preliminary Study on Pain Reduction and Shorter Length of Stay on Grade III of Internal Hemorrhoid Patients Undergoing HAL-RAR (Haemorrhoid Arteri Ligation with Recto Anal Repair) with no Doppler Guided Technique

Document Type : Research/Original Article

Authors

1 Department of Surgery, Sebelas Maret University, Indonesia

2 Medical Faculty, Sebelas Maret University, Indonesia

3 Medical Faculty, Pendidikan Ganesha University, Indonesia

Abstract

Background: Many technique has been announced in managing the internal haemorrrhoid cases, 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. The most common problem which should be discussed was the cost of this procedure, especially in routine clinical practice. We would reported the safety and effectiveness of the HAL-RAR with no Doppler guided on stage III internal haemorrhoid in single centre teaching hospital.



Methods: As a modification from the standard HAL-RAR procedure with doppler guided, we will evaluated the clincal outcome of this technique on grade III of internal hemorrhoid patients. All patients with no previous hemorrhoid surgery will be included on this study. The patients whose associated with procititis and colorectal cancer will be excluded.



Results: We reported our first 61 patients with grade III internal haemorhoid managed using modified HAL-RAR technique without Doppler guided performed during the procedure. This technique was acceptable well by the patients, pain controlled could be achieved early in the first post operative day. The average pain score (using Visual Analog Score) before discharged was 1,77 and the average length of stay was 1,36 days with no post operative bleeding found during follow up period.





Conclusion: HAL-RAR with no Doppler guided technique was safe and effective in reducing pain and the length of stay with tolerable pain controlled.

Keywords


1.Hoyuela C, Carvajal F, Juvany M, Troyano D, Trias M, Martrat A, et al. 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. Int J Surg. 2016 Apr;28:39-44.
2. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y. Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum. 2011 Feb; 54(2):226-31.
3. Walega P, Krokowicz P, Romaniszyn M, Kenig J, Sałówka J, Nowakowski M, et al. Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease. Colorectal Dis. 2010 Oct; 12(10 Online):e326-9.
4. Gomez-Rosado JC, Sanchez-Ramirez M, Capitan-Morales LC, Valdes- Hernandez J, Reyes-Diaz ML, Cintas- Catena J, et al. One year follow-up after doppler-guided haemorrhoidal artery ligation. Cir Esp. 2012 Oct; 90(8):513-7.
5. van Tol RR, van Zwietering E, Kleijnen J, Melenhorst J, Stassen LPS, Dirksen CD, et al. Towards a
core outcome set for hemorrhoidal disease-a systematic review of outcomes reported in literature.
Int J Colorectal Dis. 2018 Jul; 33(7):849-856.
6. Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal
hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III
and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017 May;21(5):337-344. doi: 10.1007/s10151-017-1620-1. Epub 2017 Apr 27. Erratum in: Tech Coloproctol. 2018 Jun;22(6):479.
7. Ratto C, Campennì P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single- center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017 Dec;21(12):953-962. doi: 10.1007/s10151-017-1726-5. Epub 2017 Nov 24. Erratum in: Tech Coloproctol. 2018 Feb 28;: PMID:29170839
8. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y. Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum. 2011 Feb;54(2):226-31. doi: 10.1007/DCR.0b013e318201d31c.
9. Gupta PJ, Kalaskar S, Taori S, Heda PS. Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids. Tech Coloproctol. 2011 Dec;15(4):439- 44. doi: 10.1007/s10151-011-0780-7. Epub 2011 Oct 28.
10. Popovtsev MA, Alekberzade AV, Krylov NN. Ligirovanie gemorroidal’nykh arterii bez ul’trazvukovoi doplernoi navigatsii v khir urgicheskom lechenii gemorroidal’noi bolezni [Hemorrhoidal artery ligation without Doppler navigation in surgical treatment of hemorrhoidal disease]. Khirurgiia (Mosk). 2021;(12):49-55. Russian. doi: 10.17116/hirurgia202112149.
11. Markaryan D, Tulina I, Garmanova T, Bredikhin M, Alikperzade A, Tsarkov P. Hemorrhoidal artery ligation with Doppler guidance vs digital guidance for grade II-III hemorrhoidal disease treatment: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore). 2020 Apr;99(15):e19424.
doi: 10.1097/MD.0000000000019424.