Hemorrhoidal disease is one of the most frequent causes of consultation in coloproctology. In the advanced stages of the disease, the treatment is surgical and the most widely used technique is the excisional hemorrhoidectomy. Surgical treatment presents a significant comorbidity, with the aim of reducing it, minimally invasive techniques have been developed, such as HAL-RAR (Doppler-guided hemorrhoidal arterial ligation and rectoanal repair). The objectives of the study are to prospectively determine the efficacy and safety of HAL-RAR in the short and medium term in the treatment of grade III-IV hemorrhoids, to study postoperative pain and the resolution of hemorrhoidal symptoms with HAL-RAR comparing it with the excisional hemorrhoidectomy, determine the safety and efficacy of the HAL-RAR in the ambulatory surgery programs of the hemorrhoids, compare the rates of persistence, recurrence and morbidity of the HAL-RAR with the excisional hemorrhoidectomy, study the impact on quality of life in patients undergoing HAL-RAR and excisional hemorrhoidectomy and determine the applicability in clinical practice of the results obtained with both techniques. For this we have carried out two studies that have been published in international journals: 1. HAL-RAR IS A SAFE AND EFFECTIVE PROCEDURE FOR THE TREATMENT OF HEMORRHOIDS. RESULTS OF A PROSPECTIVE STUDY AFTER TWO YEARS OF FOLLOW UP In 2016, we conducted a prospective study in which 30 patients operated on between June 2012 and June 2014 with grade II-IV hemorrhoidal disease were included. 29 (96.6%) patients recovered without observing postoperative complications. One patient presented necrosis of one of the hemorrhoidal cushions, so he was reoperated urgently, performing an excisional hemorrhoidectomy (Complication grade III-a of the Dindo-Clavien classification). The patient was discharged 48 hours after the second reoperation without presenting other complications. No patient was reoperated for postoperative hemorrhage and the mortality in our series was zero. 2. PROSPECTIVE AND RANDOMIZED STUDY COMPARING HAL-RAR WITH EXCISIONAL HEMORRHOIDECTOMY All patients consecutively assessed between March 2014 and October 2015, with grade II and IV haemorrhoidal pathology of the Goligher classification, with hemorrhoidal symptoms refractory to medical treatment, were included. With this study we conclude that the HAL-RAR is an effective and safe technique, with good results in the short and medium term (26 months) for the treatment of hemorrhoidal pathology grade III and IV. HAL-RAR causes less intense and shorter postoperative pain than excisional hemorrhoidectomy. In addition, the HAL-RAR achieves a resolution of the hemorrhoidal symptoms earlier and with less postoperative discomfort, especially if rectal bleeding is the main symptom. Due to the lower postoperative pain and the absence of severe complications, the HAL-RAR can be incorporated in the ambulatory surgery programs of grade III and IV hemorrhoids. The HAL-RAR presents a rate of persistence, recurrence and postoperative morbidity similar to excisional hemorrhoidectomy at 15 months of follow-up. The HAL-RAR achieves an improvement in all areas of quality of life that is maintained after one year of the intervention, the improvement in quality of life is similar to that achieved with the excisional hemorrhoidectomy. The studies carried out in our center have allowed us to modify our therapeutic algorithm for hemorrhoidal pathology to incorporate the HAL-RAR as the technique of choice for the majority of cases of grade III hemorrhoids and some cases of grade IV hemorrhoids.
HAL-RAR: ligadura arterial hemorroidal guiada por doppler y reparación recto-anal comparado con la hemorroidectomia excisional para el tratamiento de las hemorroides grado III-IV.
Carvajal Lopez, F. (Author). 26 Jun 2019
Student thesis: Doctoral thesis
Student thesis: Doctoral thesis