PROSPECTIVE OBSERVATIONAL STUDY TO EVALUATE THE EFFECTIVENESS OF HEMORRHOIDAL ARTERY LIGATION USING THE PALPATORY METHOD
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Keywords
haemorrhoidal artery ligation, haemorrhoidectomy, Doppler-guided haemorrhoidal artery ligation equipment
Abstract
Background: Hemorrhoids are enlarged and swollen vascular cushions in the anal canal . Haemorrhoids develop either due to age-related weakening of the supporting connective tissues, leading to mucosal prolapse, or as a result of abnormal blood flow through the arteriovenous shunts, causing vascular dilatation, bleeding, and eventual prolapse. They are classified as internal (above the dentate line) and external (below the dentate line). Management depends on the severity and includes conservative treatment (high-fiber diet, increased fluids, stool softeners, and topical medications), opd-based procedures (rubber band ligation, sclerotherapy, infrared coagulation), and surgical interventions (hemorrhoidectomy, stapled hemorrhoidopexy, or hemorrhoidal artery ligation) for advanced or refractory cases. Early diagnosis and appropriate treatment help relieve symptoms and prevent complications.
Methods: A observational prospective study was conducted in the Department of General Surgery at Dr.Chandramma Dayananda Sagar institute of Medical Education and Research, Bengaluru, involving 80 patients for 7 months from OCTOBER 1st 2024 to April 30th 2025. Patients aged between 20-60 years with grade II and III hemorrhoids were included in the study, to determine the effectiveness of the haemorrhoidal artery ligation via palpatory method among patients with grade II and III haemorrhoids
Results: Of the 80 patients who underwent haemorrhoidal artery ligation, 37 (43.75%) were male and 43 (53.7%) were female. The mean age was 42.76 ± 10.08 years for males and 43.52 ± 10.59 years for females. Postoperative complications occurred in 23 patients (25.3%), with rectal bleeding being the most common, followed by pain during defecation, anal fissure, fistula-in-ano, and recurrence. Most patients were discharged on postoperative day 2 and resumed normal daily activities within 5 days.
Conclusion: Palpatory haemorrhoidal artery ligation is a safe, effective, and minimally invasive treatment option for haemorrhoids. It is associated with less postoperative pain, fewer complications, and faster recovery compared with conventional open haemorrhoidectomy. Moreover, the palpatory method serves as a practical and cost-effective alternative in healthcare settings where Doppler-guided haemorrhoidal artery ligation equipment is unavailable, making it particularly valuable in resource-limited environments.
References
2. Sun Z, Migaly J. Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg,2016:29(1):22-29.
3. Alonso-Coello P, Mills E, Heels-Ansdell D. Fiber for the treatment of hemorrhoids complications: a systematic review and meta-analysis. Am J Gastroenterol,2006:101(1):181-88.
4. Iyer VS, Shrier I, Gordon PH. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum,2004:47(8):1364-70.
5. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum,1995:38(7):687-94.
6. Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: Ligation of the hemorrhoidal artery with a newly devised instrument (moricorn) in conjunction with a doppler flowmeter. Am J Gastroenterol,1995:90(2):610-13.
7. Wilkerson PM, Strbac M, Reece-Smith H, Middleton SB. Doppler-guided haemorrhoidal artery ligation: Long-term outcome and patient satisfaction. Colorectal Dis,2009:11(2):394400.
8. Schuurman PJ. Artery ligation in the treatment of hemorrhoidal disease. Thesis, Utrecht University, the Netherlands, 2012. ISBN: 978-90-393-5820-7.
9. Jeong WJ, Cho SW. One year follow-up result of doppler-guided hemorrhoidal artery ligation and recto-anal repair in 97 consecutive patients. J Korean Soc Coloproctol,2011:27(6):298-302. 19. Infantino A, Bellomo R, Dal Monte PP, Salafia C. Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study. Colorectal Dis,2010:12(8):804-09. 20. Ratto C, Donisi L, Parello A, Litta F, Doglietto GB. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum,2010:53(7):803-11.
10. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y. Dopplerguided hemorrhoidal artery ligation and rectoanal repair (HALRAR) for the treatment of grade IV hemorrhoids: longterm results in 100 consecutive patients. Dis Colon Rectum,2011:54(1):226-31.
11. Shantha Mohan NP, Chandrasekar R, Chetty V. Comparative study of manual anal dilatation with fissurectomy versus lateral anal sphincterotomy inchronic fissure in ano. Int Med J. 2016;3(2):16770.
12. Malauf AJ, Cadogan MD, Bartolo DC. Anal Canal. In: Corson JD, Robin CN, Williamson, eds. Surgery. Spain: Mosboy; 2001;21:10-11.Thomas GW, Rael LT, Bar-Or R, Shimonkevitz R, Mains CW, Slone DS, Craun ML, Bar-Or D. Mechanisms of delayed wound healing by commonly used antiseptics. J Trauma 2009; 66: 82– 91
13. Williams NS. The anus and anal canal. In: Russell RCG, Williams NS, Bulstrode CJK, eds. Bailey and Love's Short Practice of Surgery. Newyork: 2017: 1252-1255.
14. Philips R, Windsor A, Thomson J. Anorectum. In: Kired RM. General surgical operations. England: Churchill Livingstone; 2000: 357-358.
15. Antebi E, Schwartz P, Gilon E. Sclerotherapy for the treatment of fissure in ano. Surg Gynaecol Obstet. 1985;160:204-6.
16. Loder PB, Kamm MA, Nicholls RJ, Phillips RKS. Reversible chemical sphincterotomy by local application of Glyceryl trinitrate. Br J Surg. 1994;81:1386-9.
17. Lund NJ, Scholefield JM. A randomized, prospective, double blind, placebo controlled trial of Glyceryl trinitrate ointment in treatment of anal fissure. Lancet. 1997;349:11-4.
18. Gul D, Cassetta E, Anastasio G, Bentivoglio AR, Maria G, Aibanese A. Botulinum toxin for chronic anal fissure. Lancet. 1994;334:1127-8.
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