PMID- 32499984
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 5
DP  - 2020 May 3
TI  - Hemorrhoidal Artery Ligation Operations-Recto-Anal Repair (HALO-RAR) Procedure 
      for Recurrent Haemorrhoids: Excellent Patient Satisfaction.
PG  - e7944
LID - 10.7759/cureus.7944 [doi]
LID - e7944
AB  - Background Haemorrhoid is the most common anal canal disease. Treatments may 
      vary from non-invasive to invasive depending on the symptoms. Haemorrhoidectomy 
      has been widely used. However, it has some drawbacks like severe postoperative 
      pain, longer time to return to daily activities and complications such as anal 
      stenosis. To overcome these, various new treatment methods have been introduced. 
      Doppler-guided hemorrhoidal artery ligation operations (HALO) are becoming 
      popular among surgeons. HALO has been reported to have a lower recurrence rate of 
      less than 10% and higher patient satisfaction of approximately 90% with minimal 
      postoperative pain. It achieves very good postoperative outcomes in the treatment 
      of early haemorrhoids where per rectal bleeding and/or perianal discomfort are 
      main symptoms. Nevertheless, it has a limitation in the treatment of prolapsing 
      haemorrhoids. To tackle this, simultaneous recto-anal repair (RAR) has been 
      recently introduced. HALO, in combination with RAR, has been reported to achieve 
      good postoperative outcomes and excellent patient satisfaction. This is a 
      two-stage open operation. The stages are:  - Doppler-guided HALO and  - RAR 
      (recto-anal repair) Methods We are presenting a single-centre one-year experience 
      of Doppler-guided haemorrhoidal artery ligation operation and recto-anal repair 
      (DG-HALO and RAR) conducted on haemorrhoidal patients to evaluate the outcomes 
      and effectiveness of the procedure. Retrospective data were collected for the 
      patients who underwent HALO over one year period from June 2018 to August 2019. A 
      total of 10 patients were treated with the HALO-RAR procedure. Results The male 
      to female ratio was 7:3, median age was 47.98 (28.38 - 61.7) years, median body 
      mass index (BMI) was 30.23 (23.8 - 39.1). Eight patients were American Society of 
      Anesthesiologists (ASA) Grade II, one patient was ASA I and one was ASA III. Time 
      from initial consultation to the HALO procedure was 9.90 (3.5 - 19.8) months. All 
      patients complained of preoperative bleeding and six of them complained of pain 
      or discomfort. Nine patients underwent previous bandings in the clinic and one 
      patient declined banding. The average time of the procedure was 57 mins. The 
      average number of ligations was 10 (0-21). In one case, the proctoscope did not 
      pair with the speaker. The average number of plications was three (2-4). 
      Postoperatively, nine patients had no immediate complications; one patient had 
      acute urinary retention. Seven patients were discharged on the same day. One 
      patient had to stay overnight for monitoring prior to restarting apixaban, one 
      patient for his learning difficulties and one patient had an unplanned overnight 
      stay due to acute urinary retention requiring catheterization. Eight patients had 
      their first follow-up; improvement of symptoms was found in 100% patients on the 
      first follow-up. Conclusion HALO-RAR should be considered as a treatment option 
      for recurrent symptoms after banding for haemorrhoids. The study showed good 
      overall results with no immediate surgical complications. Excellent patient 
      satisfaction was found even in long-term follow-up.
CI  - Copyright (c) 2020, Miah et al.
FAU - Miah, Mohammad
AU  - Miah M
AD  - General Surgery, University Hospitals of Derby and Burton National Health Service 
      (NHS) Foundation Trust, Burton on Trent, GBR.
FAU - Centea, Daniel
AU  - Centea D
AD  - General Surgery, University Hospitals of Derby and Burton National Health Service 
      (NHS) Foundation Trust, Burton on Trent, GBR.
FAU - Michael, Gabriel
AU  - Michael G
AD  - General Surgery, University Hospitals of Derby and Burton National Health Service 
      (NHS) Foundation Trust, Burton on Trent, GBR.
FAU - Husain, Najam
AU  - Husain N
AD  - General and Colorectal Surgery, University Hospitals of Derby and Burton National 
      Health Service (NHS) Foundation Trust, Burton on Trent, GBR.
FAU - Virlos, Ioannis
AU  - Virlos I
AD  - General Surgery, University Hospitals of Derby and Burton National Health Service 
      (NHS) Foundation Trust, Burton on Trent, GBR.
FAU - Al Saramigy, Mohamad
AU  - Al Saramigy M
AD  - General Surgery, University Hospitals of Derby and Burton National Health Service 
      (NHS) Foundation Trust, Burton on Trent, GBR.
LA  - eng
PT  - Journal Article
DEP - 20200503
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7266563
OTO - NOTNLM
OT  - doppler-guided
OT  - halo (haemorrhoidal artery ligation operation)
OT  - proctoscopy
OT  - rar (recto-anal repair)
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/06/06 06:00
MHDA- 2020/06/06 06:01
PMCR- 2020/05/03
CRDT- 2020/06/06 06:00
PHST- 2020/06/06 06:00 [entrez]
PHST- 2020/06/06 06:00 [pubmed]
PHST- 2020/06/06 06:01 [medline]
PHST- 2020/05/03 00:00 [pmc-release]
AID - 10.7759/cureus.7944 [doi]
PST - epublish
SO  - Cureus. 2020 May 3;12(5):e7944. doi: 10.7759/cureus.7944.