Short- and Long-term 5-year Clinical Outcomes of Doppler-guided Hemorrhoidal Artery Ligation and Rectoanal Repair

Abstract

Introduction: To evaluate long-term clinical outcomes after Doppler-guided hemorrhoidal artery ligation (DG-HAL) and rectoanal repair (RAR) for internal hemorrhoids.
Methods: The study included patients with grades II or III internal hemorrhoids who underwent DG-HAL and RAR at our institution. Clinical characteristics, short- and long-term outcomes were prospectively collected and analyzed.
Results: Out of 36 patients, 28 had complete data and were included in the study. The mean age was 51.1 ± 15.0 years. The two most common presenting symptoms were mucosal prolapse (100%) and bleeding (82.1%). Median duration of symptoms was 20 months (range, 0.5- 240 months). The mean number of sutures was 5.6 ± 0.9 with mean operative time of 40.9 ± 9.9 minutes. The pain score, using VAS pain tool, at 24 hours after surgery was less than or equal to 5 in almost all patients (96.4%). Urinary retention, infection, anal fissure and thrombosed external hemorrhoids occurred in six (21.4%), two (7.1%), two (7.1%) and one (3.6%) patient (s), respectively. At five years, prolapse and bleeding were the two most common recurrent symptoms occurring in eight (28.6%) and six patients (21.4%) respectively.
Conclusions: Short-term clinical outcomes of patients with grades II or III internal hemorrhoids who underwent DG-HAL and RAR were modest with minor complications. Long-term outcomes were not improved when compared to historical standard open hemorrhoidectomy, while one fourth experienced recurrence.