Many treatments are currently available for hemorrhoids, including conservative treatment, instrumental treatment, and surgical treatments such as hemorrhoidectomy, stapled hemorrhoidectomy (SH), and Doppler-guided/assisted HAL. [14,15,16]. Although MMH has obvious postoperative pain, secondary bleeding, long recovery period, and other disadvantages, MMH is grade III/ It remains the preferred surgical method for patients with IV hemorrhoids. [17,18,19].
However, complications such as pain and bleeding after MMH cannot be ignored. Haksal et al. [20] Of the 206 patients who underwent MMH, 24 patients (12.9%) had bleeding symptoms within 7 days after surgery, and 2 patients reported undergoing reoperation due to bleeding. Even when multidisciplinary pain management is implemented, insufficient postoperative pain relief remains a major problem. Gerbershagen et al. [21] A retrospective analysis of 115,775 patients from 578 surgical wards of 105 hospitals in Germany found that pain after hemorrhoidectomy ranked 23rd out of 529 radical surgical procedures. Gallardo et al. [22] We found that 22.2% of patients after MMH had to take opioid analgesics. Therefore, to address these issues, we jointly developed a new combined surgical method of MMH + ND-HAL to address some of the limitations of MMH and meet the current requirements of minimally invasive surgery and rapid rehabilitation. We adopted it.
HAL cuts off the blood supply to the hemorrhoid by ligating the arteries and blood vessels that supply blood to the hemorrhoid, thereby promoting atrophy of the hemorrhoid tissue and reducing the symptoms of hemorrhoid prolapse. Compared to hemorrhoidectomy, HAL has the advantages of less pain, less bleeding, and faster recovery of working capacity, but the recurrence rate is high. [23, 24]. In this study, we found that combining HAL and MMH can leverage the benefits of each to improve efficacy and reduce recurrence rates. With HAL, you can use a Doppler probe to locate and ligate the hemorrhoidal artery, or you can palpate and ligate the artery with your fingers without using a Doppler probe. Schuermann et al. [25] conducted a blinded randomized clinical trial of HAL with and without a Doppler transducer in patients with grade II and III hemorrhoids. The results showed that HAL significantly reduced the signs and symptoms of hemorrhoid disease, but Doppler transducer did not contribute to this beneficial effect. Naqvi et al. [26] They also reported that HAL without Doppler guidance is an effective method for the treatment of hemorrhoids in terms of postoperative pain, bleeding, and patient satisfaction. Therefore, no significant differences in symptom improvement, pain, bleeding, prolapse, or other complications were observed compared with Doppler-guided HAL under direct vision. Additionally, it requires less equipment and is relatively easy to operate. During surgery, it is important to ensure that the HAL points are not coplanar, as the aim is to prevent rectal stenosis. It is also important to be careful not to ligate too many points (usually 3, 7, or 10). 11 o’clock point).
Our study results show that compared with MMH, MMH + ND-HAL reduced intraoperative bleeding (P< 0.05), indicating that ligation of the hemorrhoidal artery with ND-HAL can cut off the blood supply to the hemorrhoid, thereby reducing intraoperative bleeding. Regarding his VAS score at the first bowel movement and 12 hours, 1 day, 2 days, 3 days, and 7 days after surgery, the MMH + ND-HAL group had lower scores than his MMH group (P< 0.05). His total analgesic consumption within 7 days in the MMH + ND-HAL group was lower than that in the MMH group (P< 0.05), which indicated that MMH + ND-HAL effectively alleviated the pain of surgical incision and decreased the consumption of analgesics. Postoperative bleeding, edema, urinary retention, anal stenosis, and other complications are often associated with MMH. Our study results showed that there was no anal stenosis or anal incontinence in both patient groups. The incidence of postoperative bleeding, perianal incision edema, and acute urinary retention was lower in the MMH + ND-HAL group than in her MMH group (P< 0.05), this result indicates that the combined surgery reduces the incidence of postoperative bleeding and perianal incision edema, reduces postoperative pain, facilitates urine excretion, and provides sufficient skin or mucous membranes during surgery. cross-linking was ensured, and it was shown that there was little effect on the anus. function. Lee et al. [27] We also showed that MMH combined with HAL significantly reduced the intraoperative blood loss, postoperative bleeding, and incidence of anal edema compared with conventional MMH. After 12 months of follow-up, the recurrence rate of the MMH + ND-HAL group was lower than that of the MMH group (P< 0.05), and satisfaction was higher in the MMH + ND-HAL group than in the MMH group (P< 0.05). These results showed that combined surgery based on hemorrhoidectomy and HAL could cut off the blood supply of hemorrhoids. [28,29,30], locally causes a chronic inflammatory response, causes tissue fibrosis, and forms mucosa and submucosa that support tissue adhesion and fixation, reducing the postoperative recurrence rate and improving patient satisfaction. . At the same time, this combined surgery reduces the postoperative pain that may be associated with lifting the rectal mucosa over the internal hemorrhoids after HAL, reduces the degree of prolapse of the internal hemorrhoids, and reduces the surgical incision of the MMH. can be reduced.
Limitations of this study include the small sample size, single-center study, short postoperative follow-up, and limited results. To improve the study results, it is possible to further expand the sample size, incorporate multicenter studies, and extend the follow-up period.