title: Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease.
abstract: OBJECTIVE
  A modification of Doppler guided haemorrhoidal artery ligation (DGHAL) to include the addition of recto-anal repair is reported. Preliminary results of function and safety of third and fourth degree haemorrhoidals are given.
  
  
  METHODS
  Thirty patients underwent DGHAL combined with recto-anal-repair (RAR). Each had rectal examination, anorectal manometry and Quality of Life assessment before and 3 months after the procedure.
  
  
  RESULTS
  Twenty-nine patients were included in the final analysis. There were three (10.34%) patients of intra-operative and one (3.45%) of postoperative bleeding. Three months after RAR (17.24%) patients with minor residual mucosal prolapse were detected, three (10.34%) patients reported residual symptoms. There was no case of recurrent bleeding. Anal manometry at 3 months after RAR was significantly lower than before the procedure (P < 0.05). One (3.45%) patient reported occasional soiling 3 months after RAR.
  
  
  CONCLUSIONS
  Recto-anal-repair is safe in treating third and fourth degree haemorrhoids with no major complications and low rate of residual disease.
authors: 3rd Department of General Surgery, Jagiellonian University School of Medicine, Pradnicka, Krakow, Poland. pwalega@mp.pl
authors: P
authors: P
authors: Walega
authors: P
authors: P
authors: Krokowicz
authors: M
authors: M
authors: Romaniszyn
authors: J
authors: J
authors: Kenig
authors: J
authors: J
authors: Sałówka
authors: M
authors: M
authors: Nowakowski
authors: R M
authors: RM
authors: Herman
authors: W
authors: W
authors: Nowak
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000098:blood supply / Q000601:surgery; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy; D020700:Proctoscopes; D011391:Prolapse; D011788:Quality of Life; D013536:Suture Techniques; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal