A new technique of doppler dearterialization for hemorrhoidal disease: arterial detection ligation (ADL)
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ORIGINAL ARTICLE
A new technique of doppler dearterialization for hemorrhoidal disease: arterial detection ligation (ADL) Serkan Zenger1 · Bulent Gurbuz1 · Ugur Can1 · Tunc Yalti1,2 Received: 31 May 2020 / Accepted: 3 September 2020 © Springer Nature Singapore Pte Ltd. 2020
Abstract Purpose We describe the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating, and report our preliminary results of using this technique to treat patients with the hemorrhoidal disease (HD). Methods The subjects of this retrospective analysis were patients with symptomatic grades 2 or 3 HD. We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL. Results A total of 75 patients were included in the study (male/female ratio 1.88; mean age 48 ± 19 years; mean BMI 24 ± 3 kg/m2). Thirty-nine patients (52%) did not require hospitalization and were discharged from the day clinic approximately 4 h postoperatively. Four patients (5.3%) suffered tenesmus for about 1 week postoperatively and two (2.7%) suffered temporary rectal bleeding. The mean VAS scores 1 day postoperatively, then at 1 week, 1 month and 1 year were 2.9, 1.5, 0.4, and 0, respectively. At the 1-month follow-up, there was no sign of recurrence and the satisfaction rate was 78.6% (n = 59). At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65). Conclusion Based on our preliminary findings, ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity. We anticipate that the incidence of tenesmus, which is encountered frequently after other dearterialization methods, will be lower after the ADL technique, which avoids both mass ligation of hemorrhoidal arteries deeper than 12 mm and running a long mucopexy suture line. Keywords Arterial detection ligation · ADL · Doppler dearterialization · Hemorrhoidal disease Abbreviations HD Hemorrhoidal disease DGHAL Doppler-guided hemorrhoidal artery ligation SRA Superior rectal artery ADL Arterial Detection Ligation BMI Body mass index ASA American Society of Anesthesiologists VAS Visual Analogue Scale
* Serkan Zenger [email protected] 1
Department of General Surgery, VKF American Hospital, Guzelbahce Street, No:20, Sisli, Istanbul, Turkey
Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
2
Introduction Hemorrhoidal disease (HD) is a common disease of the anorectal region. The prevalence of symptomatic HD in the general population is 4.4%, and it is usually seen in young or middle-aged people [1]. Although a poor correlation between the grade of hemorrhoids and symptoms is often reported, the decision to perform surgery is usually based on the Goligher HD classification [2–4]. Excisional hemorrhoidectomy has been the conventional procedure for many years, but it is associated with complications such as postoperative pain and bleeding.
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