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Other Haemorrhoid Operations

Other Haemorrhoid Operations. Mo Saeed Consultant Surgeon Stepping Hill Hospital Stockport. Other Haemorrhoid Operations. Doppler Guided Haemorrhoid Artery Ligation (DG- HAL) Morinaga et al Am J Gastroenterology 1995; 90:610-3

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Other Haemorrhoid Operations

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  1. Other Haemorrhoid Operations Mo Saeed Consultant Surgeon Stepping Hill Hospital Stockport

  2. Other Haemorrhoid Operations • Doppler Guided Haemorrhoid Artery Ligation (DG- HAL) Morinaga et al Am J Gastroenterology 1995; 90:610-3 • Ligasure Haemorrhoidectomy(LH)sayfan et al Ann Surg;2001:234:21-24)

  3. DG-HAL • Embolisation of superior rectal artery and its branches results in effective treatment of bleeding from chronic haemorrhoids (Galkin et al VRS 1994;4:52-56) • Morinaga et al Am J Gastroenterology 1995; 90:610-3

  4. DG-HAL • The bases of this treatment underlies the arterial blood flow to the haemorrhoids • The anal cushions or corpus cavernosus recti (CCR) are arterio-venous anastomosis which lies above the dentate line • The functional effect of changes in arterial flow into the CCR results in a gas tight seal of the anal canal

  5. DG-HAL • Primary aim is to specifically locate & ligate terminal branches of the Superior rectal artery • Reduction in haemorrhoidal arterial blood flow resulting in shrinkage of haemorrhoidal mass • Fixate the mucosa with interruption of blood supply results in pulling up the prolapse

  6. DG-HAL • 116 patients treated for symptoms of pain, prolapse & bleeding • 1 month follow up:treatment effect observed in 96% of patients with pain 78% with prolapse 95% with bleeding

  7. What Degree of Haemorrhoids ? • Can be used for grade II-IV • Symptoms include : Bleeding Pain Prolapse • Procedure performed under sedation

  8. DG-HAL • Recent longer term outcome data • Felice et al DCR 2005; 48: 2090-2093 • Greenberg et al DCR 2006; 49: 485-489

  9. Felice et al 68 consecutive patients with grade III haemorrhoids treated with DG-HAL. Mean F/U 11 months (3-18) : pain completely resolve in 8/11 & improved in the remaining 3 bleeding completely resolved in 51/56 (91%) prolapse resolved in 64/68 (94%) Complications: 5 persistent pain > 2 day in 2 patients 2 patients had thrombosis of 1 haemorrhoid 1 patient developed 20 haemorrhage DG- HAL

  10. DG-HAL • Greenberg et al DCR 2006; 49: 485-489 Treated 100 patients with grade II (19) or III (81) haemorrhoids 42 males 58 females. F/U 3,6 & 12 months: 95 discharged after 2-4 hours 96 patients completed 1 year f/u & 85 were asymptomatic 11 patients had persistent bleeding & required further treatment

  11. DG- HAL • Anopexy- Changes to the design of the proctoscope now allows placement of a suture to lift the prolapsing tissue. • This will improve results for prolapse but may be associated with patient discomfort

  12. DG-HAL • Effective minimally invasive treatment for haemorrhoids • Can be performed under sedation • Randomised controlled trial vs other treatments needed • Longer term F/U

  13. Ligasure Haemorrhoidectomy • The underlying principle of ligasure haemorrhoidectomy is the same as that for the standard Ferguson method with the only difference being the choice of diathermy • Ligasure is a bipolar diathermy that provides energy and pressure to seals vessels and tissue bundles • It produces minimal sticking,charring or thermal spread to adjacent tissues

  14. Ligasure Haemorrhoidectomy (LH) • First described bysayfan et al Ann Surg;2001:234:21-24) • Several randomised controlled trials comparing LigasureTM haemorrhoidectomy with conventional diathermy haemorrhoidectomy

  15. Ligasure Haemorrhoidectomy • Franklin et al DCR 2003; 46:1380-1383 compared ligasure with conventional diatherny haemorrhoidectomy: Main findings were reduced 1. operating time (6vs11mins) 2. post op pain at days 1 & 14 In the ligasure group

  16. Ligasure Haemorrhoidectomy • Palazzo et al BJS 2002;89:154-157 Ligasure haemorrhoidectomy reduced operating time and analgesic requirements but the postoperative pain was similar to that with conventional diathermy haemorrhoidectomy

  17. Ligasure Haemorrhoidectomy • Jayne et al BJS 2002: 89;428-32 Demonstrated reduced blood loss, shortened operating time & reduced pain for ligasure compared to conventional diathermy haemorrhoidectomy facilitating sameday discharge

  18. Ligasure Haemorrhoidectomy • Kraemer et al DCR 2005;48:1517-1522 Prospective randomised study comparing PPH with Ligasure haemorrhoidectomy 50 patients • No differences in post op pain, patient satisfaction or length of operation between the two techniques

  19. Ligasure Haemorrhoidectomy • Ligasure haemorrhoidectomy is safe & effective technique for the treatment of grade 3 & 4 haemorrhoids • Cost of the equipment can be offset by daycase treatment of patients

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