Three Years Recurrence Free of Hemorrhoid Artery Ligation-Rectoanal Repair with No Doppler Guided on Grade III of Internal Hemorrhoid Disease

Abstract

BACKGROUND: Surgical treatment of internal hemorrhoid is still challenging, short- and long-term clinical outcome were the most common issue. Chronic pain and recurrence case are the most common problem. Since it has been announced, HAL-RAR with Doppler guided is the treatment of choice, although it has economic issue on using this standard technique especially in the developing country which has limitation on health insurance. AIM: Using the same procedure as the standard HAL-RAR procedure and direct vision ligation, we hope that it could evaluate the clinical response of these modification technique on symptomatic Grade III of internal hemorrhoid cases. METHODS: We will evaluate the long-term clinical outcome of modified no Doppler guided technique on grade III of internal hemorrhoid cases. The inclusion criteria are the grade III of internal hemorrhoid, not associated with rectal cancer. A history of previous procedure or recurrence disease will be excluded from the study. Post-operative pain, 3 years recurrence disease, will be evaluated. RESULTS: We reported 65 patients, both of them have pain and bleeding. The procedure can be performed safely using direct vision and rectoscope. After 3 years, we reported there was no recurrence disease, no post-operative bleeding, and tolerable post-operative pain. We reported one case of chronic pain due to proctitis and could be managed conservatively. CONCLUSION: No Doppler-guided HAL-RAR was effective in controlling the post-operative pain, acceptable long-term clinical outcome with no recurrence.