Haemorrhoid artery ligation – recto anal repair (HAL-RAR) blind versus Doppler: a systematic review and meta-analysis

IF 1.6 4区医学 Q3 SURGERY ANZ Journal of Surgery Pub Date : 2024-10-28 DOI:10.1111/ans.19258

Amos Nepacina Liew MBBS, MS, Jason Wang B-BMED, MD, Michelle Zhiyun Chen MBBS, MS, FRACS, Yeng Kwang Tay MBBS, FRACS, Joseph C.H. Kong MBChB, FRACS, PhD

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Abstract

Background

Haemorrhoids remain a highly prevalent condition in Australia, affecting 39% of the adult Australian population. While haemorrhoidectomy remains the gold standard in the management of haemorrhoids, newer techniques such as haemorrhoid artery ligation-recto anal repair (HAL-RAR) are emerging as promising management modalities. We compare the efficacy of non-Doppler guided (non-DG) HAL-RAR versus Doppler-guided (DG) HAL-RAR in the management of haemorrhoids.

Methods

This study was registered with PROSPERO (CRD42022353806) and adhered to PRISMA 2020 guidelines. We conducted a systematic review using Medline, Embase and Cochrane database for comparative studies between Doppler-guided HAL-RAR and non-Doppler-guided HAL-RAR in accordance with the PRISMA 2020 statement for reporting systematic reviews.

Results

Five studies were included in our systematic review and meta-analysis. There was no clinically significant difference in operative times (SMD 0.46, 9% CI −3.16 0 4.08, P = 0.804) or post-operative bleeding (P = 0.142) between the two groups. DG HAL-RAR patients were more likely to have post-operative urinary retention (P < 0.001). Non-DG patients were less likely to experience recurrence (OR 5.12, P < 0.001).

Conclusion

Our review of non-DG HAL-RAR compared to DG HAL-RAR reflects the non-inferiority of the non-DG HALRAR procedure. We hope that these results would provide a guide to clinicians performing HAL-RAR, and would provide some cost savings for institutions who are unable to procure the necessary equipment for DG HAL-RAR.

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痔动脉结扎-直肠肛门修补术（HAL-RAR）盲法与多普勒法：系统回顾与荟萃分析。

背景：在澳大利亚，痔疮仍然是一种高发疾病，39% 的澳大利亚成年人患有痔疮。虽然痔疮切除术仍是治疗痔疮的金标准，但痔动脉结扎-直肠肛门修补术（HAL-RAR）等新技术正在成为有前途的治疗方式。我们比较了非多普勒引导（non-DG）HAL-RAR 与多普勒引导（DG）HAL-RAR 在治疗痔疮方面的疗效：本研究已在 PROSPERO（CRD42022353806）注册，并遵守 PRISMA 2020 指南。根据 PRISMA 2020 系统综述报告声明，我们使用 Medline、Embase 和 Cochrane 数据库对多普勒引导下 HAL-RAR 和非多普勒引导下 HAL-RAR 的比较研究进行了系统综述：我们的系统综述和荟萃分析纳入了五项研究。两组患者的手术时间（SMD 0.46，9% CI -3.16 0 4.08，P = 0.804）或术后出血量（P = 0.142）无明显临床差异。DG HAL-RAR 患者术后出现尿潴留的可能性更大（P=0.142）：我们对非 DG HAL-RAR 与 DG HAL-RAR 的比较结果表明，非 DG HALRAR 手术并无劣势。我们希望这些结果能为实施 HAL-RAR 的临床医生提供指导，并为那些无法采购 DG HAL-RAR 所需的设备的医疗机构节约一定的成本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ANZ Journal of Surgery 医学-外科

CiteScore

2.50

自引率

11.80%

发文量

720

审稿时长

2 months

期刊介绍： ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.