HAC (Russian)
RSCI (Russian)
EBSCO
DOI (USA)
Ulrichsweb (Ulrich’s Periodicals Directory)
Scientific Indexing Services

Deleting, fixing, or dearterizing nodes? In search of optimal pathogenetic treatment for hemorrhoid disease

DOI: https://doi.org/10.29296/25877305-2021-03-03
Issue: 
3
Year: 
2021

M. Popovtsev; Professor A. Alekberzade, MD; Professor N. Krylov, MD I.M. Sechenov First Moscow
State Medical University (Sechenov University) , Ministry of Health of Russia

The literature review provides information about the principles of radical pathogenetic treatment for hemorrhoid disease (HD), the emergence and further development of donor techniques that have served as the basis for developing the hemorrhoidal artery ligation and rectoanal (HAL-RAR) technology; and analyzes the reasons for its effectiveness due to the combination of two different approaches that have evolved independently of one another until a certain moment. The combination of these techniques has been incentive to a technological breakthrough in the treatment of HD and to the better quality of life in patients after surgical treatment. HAL-RAR has proven to be a highly effective and safe technique for the surgical treatment of HD. The relatively rare failures that occur after the HAL-RAR technology and lead to the need for resection procedures in the future do not reduce its popularity. One of the main advantages of this technology is the simplicity of its technical execution and minimal requirements for the skill and experience of the operator. Another important feature may be considered to be the ability to adapt the HAL-RAR technology for use in both outpatient settings and day hospitals without the need for long-term medical observation of patients.

Keywords: 
coloproctology
surgery
hemorrhoid disease
hemorrhoidectomy
desarterization of internal hemorrhoidal nodes
lifting of internal hemorrhoidal nodes
HAL-RAR technology



References: 
  1. Ganz R.A. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol. 2013; 11: 593–603. https://doi.org/10.1016/j.cgh.2012.12.020
  2. Santos G. de A., Coutinho C.P., Matta M. Surgical complications in 2,840 cases of hemorrhoidectomy by Milligan-Morgan, Ferguson and combined techniques. J Coloproctol (Rio de Janeiro). 2012; 32 (3): 271–90. http://dx.doi.org/10.1590/S2237-93632012000300011
  3. Agbo S.P. Surgical management of hemorrhoids. J Surg Tech Case Rep. 2011; 3 (2): 68–75. DOI: 10.4103/2006-8808.92797
  4. Ho Y.H., Buettner P.G. Open compared with closed haemorrhoidectomy: meta-analysis of randomized controlled trials. Tech Coloproctol. 2007; 11: 135–43. DOI: 10.1007/s10151-007-0343-0
  5. Bhatti M.I., Shafique M., Mirza S. et al. Milligan–Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg. 2016; 40 (6): 1509–19. DOI: 10.1007/s00268-016-3419-z
  6. Mattana C., Coco C., Manno A. et al. Stapled hemorrhoidopexy and Milligan Morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: Long-term evaluation and clinical results. Dis Colon Rectum. 2007; 50 (11): 1770–5. DOI: 10.1007/s10350-007-0294-6
  7. Elmér S.E., Nygren J.O., Lenander C.E. A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum. 2013; 56 (4): 484–90. DOI: 10.1097/DCR.0b013e31827a8567
  8. Guenin M.-O., Rosenthal R., Kern B. et al. Ferguson hemorrhoidectomy: long-term results and patient satisfaction after Ferguson’s hemorrhoidectomy. Dis Colon Rectum. 2005; 48 (8): 1523–7. DOI: 10.1007/s10350-005-0084-y
  9. Kuz'minov A.M., Borisov I.F. Gemorroidektomija s primeneniem vysokih energij. Koloproktologija. 2009; 3 (29): 46–51 [Kuzminov A.M.. Borisov I.F. Gemorroidektomiya s primeneniyem vysokikh energiy. Koloproktologiya. 2009; 3 (29): 46–51 (in Rus).].
  10. Altomare D.F., Milito G., Andreoli R. et al. Ligasure™ Precise vs. conventional diathermy for Milligan-Morgan haemorrhoidectomy: a prospective, randomized, multicenter trial. Dis Colon Rectum. 2008; 51 (5): 514–9. DOI: 10.1007/s10350-007-9171-6
  11. Senagore A., Mazier W.P., Luchtefeld M.A. et al. Treatment of advanced hemorrhoidal disease: aprospective randomized comparison of cold scalpel versus contact Nd-Yd laser. Dis Colon Rectum. 1993; 36 (11): 1042–9. DOI: 10.1007/BF02047297
  12. Muzi M.G., Milito G., Nigro C. et al. Randomized clinical trial of Ligasure™ and conventional diathermy haemorrhoidectomy. Br J Surg. 2007; 94 (8): 937–42. DOI: 10.1002/bjs.5904
  13. Mastakov M.Y., Buettner P.G., Ho Y.H. Updated meta-analysis of randomized controlled trials comparing conventional excisional haemorrhoidectomy with Ligasure™ for haemorrhoids. Tech Coloproctol. 2008; 12 (3): 229–39. DOI: 10.1007/s10151-008-0426-6
  14. Gupta P.J. A comparative study between radiofrequency ablation with placation and Milligan-Morgan hemorrhoidectomy for grade III hemorrhoids. Tech Coloproctol. 2004; 8: 163–8. https://doi.org/10.1007/s10151-004-0081-5
  15. Yang J., Cui P.J., Han H.Z. et al. Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy. World J Gastroenterol. 2013; 19 (29): 4799–807. DOI: 10.3748/wjg.v19.i29.4799
  16. Lee K.C., Chen H.H., Chung K.C. et al. Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults. Int J Surg. 2013; 11 (9): 914–8. DOI: 10.1016/j.ijsu.2013.07.006
  17. Naldini G., Sturiale A. Stapled hemorrhoidopexy and THD/HAL-RAR: false myths of the third millennium. Tech Coloproctol. 2020; 24 (9): 985–6. DOI: 10.1007/s10151-020-02267-w
  18. Shao W.J., Li G.C., Zhang Z.H. et al. Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg. 2008; 95: 147–60. DOI: 10.1002/bjs.6078
  19. Jayaraman S., Colquhoun P.H.D., Malthaner R.A. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007; 9 (50): 1297–305. DOI: 10.1007/s10350-007-0308-4
  20. Mattana C., Coco C., Manno A. et al. Stapled hemorrhoidopexy and Milligan Morgan hemorrhoidectomy in the cure of fourth-degree hemorrhoids: Long-term evaluation and clinical results. Dis Colon Rectum. 2007; 50 (11): 1770–5. DOI: 10.1007/s10350-007-0294-6
  21. Gupta P.J., Kalaskar S. Ligation and mucopexy for prolapsing hemorrhoids – a ten year experience. Ann Surg Innov Res. 2008; 2: 5–8. DOI: 10.1186/1750-1164-2-5
  22. Kim J.C. Analysis of surgical treatments for circumferentially protruding haemorrhoids: complete excision with repair using flaps versus primary excision with secondary suture-ligation. Asian J Surg. 2006; 29 (3): 128–34. DOI: 10.1016/S1015-9584(09)60071-3
  23. Gaj F., Trecca A., Crispino P. Transfixed stitches technique versus open haemorrhoidectomy. Results of a randomised trial. Chir Ital. 2007; 59 (2): 231–5.
  24. Wang Z.J., Tang X.Y., Wang D. et al. The pathological characters and its clinical significance of internal hemorrhoids. Zhonghua Wai Ke Za Zhi. 2006; 44: 177–80.
  25. Ratto C., Campenni P., Papeo F. et al. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 201; 22 (3): 953–62. DOI: 10.1007/s10151-018-1765-6
  26. Sohn N., Aronoff J.S., Cohen F.S. et al. Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg. 2001; 5 (182): 515–9. DOI: 10.1016/s0002-9610(01)00759-0
  27. Giordano P., Overton J., Gravante G. Transanal Hemorrhoidal Dearterialization: A Systematic Review. Dis Colon Rectum. 2009; 52 (9): 1665–71. DOI: 10.1007/DCR.0b013e3181af50f4
  28. Pucher P.H., Sodergren M.H., Lord A.C. et al. Clinical outcome following Doppler-guided haemorrhoidal artery ligation: a systematic review. Colorectal Dis. 2013; 15 (6): e284-94. DOI: 10.1111/codi.12205
  29. Wilkerson P.M., Strbac M., Reece-Smith H. et al. Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction. Colorectal Dis. 2009; 11 (4): 394–400. DOI: 10.1111/j.1463-1318.2008.01602.x
  30. Avital S., Inbar R., Karin E. et al. Five-year follow-up of Doppler-guided hemorrhoidal artery ligation. Tech Coloproctol. 2012; 16 (1): 61–5. DOI: 10.1007/s10151-011-0801-6
  31. Dal Monte P.P., Tagariello C., Sarago M. et al. Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol. 2007; 11 (4): 333–9. DOI: 10.1007/s10151-007-0376-4
  32. Faucheron J.-L., Gangner Y. Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and three-year follow-up results in 100 consecutive patients. Dis Colon Rectum. 2008; 51 (6): 945–9. DOI: 10.1007/s10350-008-9201-z
  33. Trenti L., Biondo S., Galvez A. et al. 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. 2018; 22 (6): 479. DOI: 10.1007/s10151-018-1805-2
  34. Hoyuela C., Carvajal F., Juvany M. 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; 28: 39–44. DOI: 10.1016/j.ijsu.2016.02.030
  35. Carvajal L.F., Hoyuela A.C., Juvany G.M. et al. Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life. J Surg Innov. 2019; 26 (3): 328–36. DOI: 10.1177/1553350618822644
  36. Banai Z., Harkai Z., Király L. et al. HAL-RAR for the treatment of hemorrhoids – a new, non invasive method. Magy Seb. 2019; 72 (4): 161–6. DOI: 10.1556/1046.72.2019.4.2
  37. Roka S., Gold D., Walega P. et al. DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month multi-centre, prospective observational study. Eur Surg. 2013; 45: 26–30. DOI 10.1007/s10353-012-0182-8
  38. Infantino A., Altomare D.F., Bottini C. et al. THD group of the SICCR (Italian Society of Colorectal Surgery). Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis. 2012; 2 (14): 205–11. https://doi.org/10.1111/j.1463-1318.2011.02628.x
  39. Denoya P.I., Fakhoury M., Chang K. et al. Dearterialization with mucopexy versus haemorrhoidectomy for grade III or IV haemorrhoids: short-term results of a double-blind randomized controlled trial. Colorectal Dis. 2013; 15 (10): 1281–8. DOI: 10.1111/codi.12303
  40. Denoya P., Tam J., Bergamaschi R. Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial. Tech Coloproctol. 2014; 18 (11): 1081–5. DOI: 10.1007/s10151-014-1219-8