HAL-RAR Literature Slide

Summaries by PT Dian Langgeng Pratama, Fahrenheit
Medical Team, 2014.

Patients Recruitment
Inclusion Criteria :
Exclusion criteria :

Any prolapse which could be reduced was classified as concomitant anal disease (acute thrombosed
grade III hemorrhoidal disease.
hemorrhoids,fissure, abscess, fistula, incontinence,

inflammatory bowel disease), previous anal surgery,
Permanently prolapsed anal cushion that prolapse ongoing treatment with oral anticoagulants, disease or
immediately after replacement were classified as grade IV.
hematological disorders.

Other underlying pathologies were excluded by barium The patients were classified in category I-II of the ASA
enema or colonoscopy where necessary. score (American Society of Anesthesiologists).

Diagnosis & staging of the disease using rigid sigmoidoscopy & Anoscopy
Randomization
n= 135 (grade III-IV hemorrhoids)
Closed Hemorrhoidectomy HAL-RAR

n= 70 n= 65
RESULT
RESULT
Conclusion: HAL-RAR appears to cause less postoperative pain and results in better patient-satisfaction in the early postoperative
period than closed hemorrhoidectomy. Doppler-guided hemorrhoidal artery ligation fulfills the requirements of minimally invasive
surgery and appears to be ideal for 1-day surgery
Doppler Guided Hemorrhoidal Artery Ligation (DG-Hal) : a Safe
Treatment of II-III Degree Hemorrhoids for all Patients. Could it be
potentially also good prophylaxis?
A. Testa, G. Torino.
Department of Surgery, S. Peter Hospital FBF, Rome, Italy
Pediatric Surgery Unit, G. Salesi Children’s Hospital, Ancona, Italy.
Aim of the study : To evaluate the efficacy, safety and invasivity of

Hal Doppler technique to treat II and III degree
hemorrhoids.
Methods : Retrospective observational study of 128 patients with

II-III degree hemorrhoids then follow up was performed
from 5 up to 72 months (average observation 36.5
months).
12 Hours & 7 Days Post Surgery Follow up
6 Months & Annual Post Surgery Follow up
Conclusion
•  The HAL Doppler Technique is safe and easy to perform.

•  Might be considered as the first choice treatment in the therapy of II and III degree hemorrhoids
characterized by bleeding.
•  The HAL Doppler Technique surpasses the surgical alternatives (hemorrhoidectomy or prolassectomy)
with reference to operative trauma, complications and post operative discomfort, obtaining satisfying
result.
•  The HAL Doppler Technique due to its low invasiveness can be done to patients with neurological, hepatic
and hematologic problems who are often excluded from conventional treatments due to high risk of
complications.
•  Low discomfort during the operation and the absence of complications justify the use of HAL Doppler also in
patients affected by the most precocious degree of haemorhoidal illness.
•  The HAL Doppler Technique both therapeutical procedur and prophylaxis of the most advance degree of
haemorrhoidal illness may be performed at the same time.
•  The aim of the study : To review several technical aspects and analyze 1-year results of this method (DG-HAL/RAR) in
terms of recurrence of prolapse and symptoms other than prolapse.
•  Patients & Method : Prospective Observational Study, multicenter (7 proctologic institution)
•  Inclusion criteria : Patients aged 18-80 years with symptomatic grade III and IV haemorrhoidal
disease according to Goligher classification.
•  Exclusion criteria : Patients with a history of prior anal surgery and those considered unfit for surgery pregnant
woman and those in puerpureum.
Patients Data & Surgical Procedure
Pa#ents profile Surgical Procedure
n 184 Median of Liga#on 6(2-‐11)

male 120 (65%) Prolapse-‐reduc#on sutures (PRSs) 3(1-‐9)
Female 64 (35%) % pa#ents with 6 or more liga#on 80%
Median Age (years) 46.8 (23-‐76)
% pa#ents with 3 or more PRSs 80%
III Degree Hemorrhoids 107(58%)
Surgery under general anesthesia (Ptn) 132 (72%)
IV Degree Hemorrhoids 77(42%)
Surgery under spinal anesthesia (Ptn) 45(25%)
Surgery under local Anesthesia (Ptn) 7(4%)
Preopera#ve symptoms Mean Opera#ng #me (minute) 35(13-‐75)
Instance of significant bleeding (Ptn) 3 (2%)
Post opera#ve complica#on (Ptn) 14(8%)
Pain 136/184 (74%) Bleeding which required opera#ve revision (Ptn) 2(1%)
Perianal thromboses (Ptn) 11(7%)
Itching 139/184 (76%) Unspecified proc##s (ptn) 1(1%)
Mean Hospital stays (Days) 2.3
Bleeding 174/184 (95%)
Post Operative Follow up
Conclusion
•  HAR-HAR proved to be safe & effective

•  Showing acceptable prolapse RR of 11% after 12 months for high grade haemorrhoid patients (59% grade
III, 41% grade IV)
•  Symptom control & high patients satisfaction (9 of 10 patients staying symptom free and satisfied 1 year
after surgery.
•  Low perioperative complication, primarily cases of perianal thrombosis and post operative bleeding.
Objective : To describe our experience with this combined procedure in the treatment of grade IV hemorrhoids
Design : Prospective Observational Study
Setting : Outpatients Colorectal Surgery Unit
Patients : Consecutive patients with grade IV hemorrhoids treated from April 2006 to December 2008
Intervention : Hemorrhoidal Artery Ligation-Rectoanal Repair (HAL-RAR)
Main Outcome Measures : Operating time, Number of Ligation, Number of mucopexies and associated procedures and post operative
symptoms were recorded. Pain was graded on a visual analog scale, follow up was at 2,6 and 12 months
after surgery and then annually.
Result
Surgical Procedure
Complica#ons
Median of Liga#on 9(4-‐14)
Surgery under general anesthesia (Ptn) 29 Dyschezia las#ng for 31 months 1
Mean Opera#ng #me (minute) 35(17-‐60)
n Pa#ents discharge aXer opera#on 84 Anal Incon#nence at 4 months 1
n pa#ents remained hospitaliza#on for 2 days 11
n pa#ents remained hospitaliza#on for 3 days 3 Thrombosis of residual piles at 4 months 1
n pa#ents remained hospitaliza#on for 4 days 2
The mean follow up 34(14-‐42) Anal Fissure at 12 months 1
CONCLUSION
Doppler-guided HAL-RAR is safe, easy to perform and can be tailored to suit each individual case. This
procedure shoul be considered as an effective treatment option for grade IV hemorrhoids
Aim of the study: To observe the outcome of a series of consecutive DG HAL-RAR procedures
Method : Seventy seven consecutive patients (49 male) underwent DG-HALRAR for symptomatic
hemorrhoids and were reviewed for 6 months post surgery.
Pre-Operative & Surgical Procedure
Pa#ents profile
80 Patients perform n 77
HAL-RAR surgery male 49
Female 28
Median Age (years) 50
Mean Follow up (Months) 13.21(6-‐21)
II Degree Hemorrhoids 12
III Degree Hemorrhoids 65
6 Month Post Prolapse+Bleeding symptoms 57 (74%)
Surgery Follow up
Surgical Procedure
Median of Liga#on 6(1-‐9)

Patients not
followed up 6 Median No. of RARs performed 2(1-‐5)
months : 3
Surgery under general anesthesia (Ptn) 55
Surgery received seda#on and pa#ents controlled analgesia 22
n Pa#ents discharge aXer opera#on 74(96.1%)
Patients Followed up n pa#ents stay overnight 2(2.5%)

for 6 months : 77
n pa#ents stayed for 3 days 1(1.2%)
Post-operative & Follow up
Conclusion:
•  DG-HAL-RAR is safe and effective minimally invasive technique that can be used for symptomatic haemorrhoids.
•  DG-HAL-RAR can be performed as a day case procedure, under sedation.
•  DG-HAL-RAR is easy to learn and although more painfull than DGHAL alone is well tolerated with high patients
satisfaction rates.
•  The addition of RAR appears to improve the outcome of DGHAL in improving the outcome for patients suffering
prolapse as a prominent symptom.
•  Recurrent symptoms following DGHAL-RAR can be treated by repeate DGHAL-RAR or any other form of
therapeutic intervention, however it is rarely necessary to perform conventional, painful and potentially
dangerous excisional procedures.
§  n = 83 (43% female, 57% male) I II III IV
§  Mean age = 56 years (range 20-83)) Grade: 90% 10%
§  Follow-up was carried out at 1 week, and then at 1, 3, 6 and 12 months, whereby
clinically relevant parameters such as hemorrhoidal symptoms and re-prolapse were
recorded and the spatial distribution of treated arteries analysed
§  Observation time: 12 months
§  Results:
§  The number of patients showing relief of hemorrhoidal symptoms at 12-month follow-up was
high.
§  Patient satisfaction was consistently high (>90%) at all follow-up intervals and the
complication rate was low.
Criteria resolved Results

Bleeding 89%
Itching 95 %
Burning & Soiling in 100%
No Re-prolapse 89%
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Summaries by PT Dian Langgeng Pratama, Fahrenheit

Medical Team, 2014.

Closed Hemorrhoidectomy HAL-RAR

Aim of the study : To evaluate the efficacy, safety and invasivity of

Methods : Retrospective observational study of 128 patients with

•  The HAL Doppler Technique is safe and easy to perform.

•  Patients & Method : Prospective Observational Study, multicenter (7 proctologic institution)

n 184 Median of Liga#on 6(2-‐11)

•  HAR-HAR proved to be safe & effective

Design : Prospective Observational Study

Setting : Outpatients Colorectal Surgery Unit

Intervention : Hemorrhoidal Artery Ligation-Rectoanal Repair (HAL-RAR)

Median of Liga#on 6(1-‐9)

Surgery received seda#on and pa#ents controlled analgesia 22

n Pa#ents discharge aXer opera#on 74(96.1%)

Patients Followed up n pa#ents stay overnight 2(2.5%)

Criteria resolved Results

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HAL-RAR Literature Slide

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Summaries by PT Dian Langgeng Pratama, Fahrenheit

Medical Team, 2014.

Closed Hemorrhoidectomy HAL-RAR

Aim of the study : To evaluate the efficacy, safety and invasivity of

Methods : Retrospective observational study of 128 patients with

• The HAL Doppler Technique is safe and easy to perform.

• Patients & Method : Prospective Observational Study, multicenter (7 proctologic institution)

n 184 Median of Liga#on 6(2-­‐11)

• HAR-HAR proved to be safe & effective

Design : Prospective Observational Study

Setting : Outpatients Colorectal Surgery Unit

Intervention : Hemorrhoidal Artery Ligation-Rectoanal Repair (HAL-RAR)

Median of Liga#on 6(1-­‐9)

Surgery received seda#on and pa#ents controlled analgesia 22

n Pa#ents discharge aXer opera#on 74(96.1%)

Patients Followed up n pa#ents stay overnight 2(2.5%)

Criteria resolved Results

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

•  The HAL Doppler Technique is safe and easy to perform.

•  Patients & Method : Prospective Observational Study, multicenter (7 proctologic institution)

n 184 Median of Liga#on 6(2-‐11)

•  HAR-HAR proved to be safe & effective

Median of Liga#on 6(1-‐9)