Haemorrhoidal artery ligation: Is Doppler guidance useful? A systematic review and meta-analysis of randomized controlled trials

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Colorectal Disease Pub Date : 2025-07-15 DOI:10.1111/codi.70163

Roberta Tutino, Arcangelo Picciariello, Mauro Santarelli, Veronica De Simone, Pierluigi Lobascio, Gianfranco Cocorullo, Marco Massani, Giusi Graziano, Giulio Aniello Santoro, Gaetano Gallo

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引用次数: 0

Abstract

Aim

Haemorrhoidal arterial ligation (HAL) with or without mucopexy (recto-anal repair, RAR) is a minimally invasive technique for the treatment of haemorrhoidal disease. It is still debated if it should be performed with Doppler guidance (DG-HAL) or without. The primary aim of this study was to find evidence that the use of Doppler guidance reduces the risk of recurrence. The secondary aim was to evaluate the benefit of Doppler guidance on postoperative complications.

Methods

A comprehensive literature search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (2020). The population, intervention, comparison, outcomes and study design (PICOS) framework was used for eligibility criteria. Data were extracted independently by two reviewers for initial screening and for eligibility to be included in the meta-analysis of randomized controlled trials. Random effects meta-analysis, leave-one-out meta-analysis and meta-regression were performed to assess the main outcomes.

Results

Seven randomized controlled trials, published between 2008 and 2023, were selected. They included 514 patients (mean age 49.13 years, 46% men) with different haemorrhoidal degrees. The HAL technique was performed in 255 patients and DG-HAL in 259 patients. The meta-analysis revealed that the DG-HAL procedure was associated with a significant risk of recurrence (P = 0.007) and similar postoperative pain (P = 0.623) compared to the HAL procedure. In a subgroup analysis of patients treated with a combined RAR procedure, no differences were found between the DG-HAL-RAR and HAL-RAR regarding the risk of recurrence (P = 0.36) and postoperative pain (P = 0.31).

Conclusion

In conclusion, this meta-analysis did not find superiority of DG-HAL over HAL with or without RAR in reducing postoperative complications and recurrence.

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痔动脉结扎术：多普勒引导有用吗？随机对照试验的系统回顾和荟萃分析

目的痔动脉结扎术（HAL）伴或不伴黏液固定术（直肠-肛门修复术，RAR）是治疗痔病的一种微创技术。在多普勒制导（DG-HAL）或无多普勒制导的情况下，仍有争议。本研究的主要目的是寻找多普勒引导降低复发风险的证据。第二个目的是评估多普勒引导对术后并发症的益处。方法根据系统评价和荟萃分析首选报告项目（PRISMA）指南（2020）进行全面的文献检索。采用人群、干预、比较、结果和研究设计（PICOS）框架作为入选标准。数据由两位审稿人独立提取，用于初始筛选和纳入随机对照试验的荟萃分析的资格。采用随机效应荟萃分析、留一荟萃分析和元回归对主要结局进行评估。结果选取2008 - 2023年间发表的7项随机对照试验。共纳入514例不同程度痔疮患者（平均年龄49.13岁，男性46%）。255例采用HAL技术，259例采用DG-HAL技术。荟萃分析显示，与HAL手术相比，DG-HAL手术与显著的复发风险（P = 0.007）和相似的术后疼痛（P = 0.623）相关。在接受联合RAR治疗的患者的亚组分析中，DG-HAL-RAR和HAL-RAR在复发风险（P = 0.36）和术后疼痛（P = 0.31）方面没有差异。综上所述，本荟萃分析并未发现DG-HAL在减少术后并发症和复发方面优于HAL合并或不合并RAR。

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来源期刊

Colorectal Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

11.80%

发文量

406

审稿时长

1.5 months

期刊介绍： Diseases of the colon and rectum are common and offer a number of exciting challenges. Clinical, diagnostic and basic science research is expanding rapidly. There is increasing demand from purchasers of health care and patients for clinicians to keep abreast of the latest research and developments, and to translate these into routine practice. Technological advances in diagnosis, surgical technique, new pharmaceuticals, molecular genetics and other basic sciences have transformed many aspects of how these diseases are managed. Such progress will accelerate. Colorectal Disease offers a real benefit to subscribers and authors. It is first and foremost a vehicle for publishing original research relating to the demanding, rapidly expanding field of colorectal diseases. Essential for surgeons, pathologists, oncologists, gastroenterologists and health professionals caring for patients with a disease of the lower GI tract, Colorectal Disease furthers education and inter-professional development by including regular review articles and discussions of current controversies. Note that the journal does not usually accept paediatric surgical papers.