Doppler-guided hemorrhoidal artery ligation with mucopexy versus stapled hemorrhoidopexy in the management of grades 3 and 4 prolapsed hemorrhoids: A prospective randomized clinical study

Background: Hemorrhoids are a common anorectal condition causing disability and discomfort in symptomatic patients. Several less invasive techniques including stapled hemorrhoidectomy (SH) and Doppler-guided hemorrhoidal artery ligation (DHL) with mucopexy have been introduced. In our study, we aim to compare these two techniques. Patients and Methods: We included patients with symptomatic grade 3 or 4 prolapsed piles, aged from 18 to 70 years, who underwent either SH or DHL with mucopexy at the General Surgery Department, Ain Shams University hospitals. We excluded patients with previous anal surgery, hemorrhoids accompanied by other anal conditions such as fissure, fistula, or anal stenosis, impaired anal sphincter function or fecal incontinence, recurrent or complicated hemorrhoids. Patients with debilitating disease or American Society of Anesthesiologists III or IV were also excluded. Results: From July 2021 to July 2023, 40 patients were prospectively included in our study. Twenty patients had DHL with mucopexy with a mean age of 35.3±8.8, while 20 patients underwent SH operation with a mean age 34.8±7.3. Both techniques were comparable with no significant difference between them regarding any of the postoperative anal symptoms, except pain, during 1, 3, 6, 12, and 18 months of follow-up. Longo (SH) operation has significantly higher early postoperative pain, using the visual analog scale score, compared with DHL (1 month, P=0.03 , 3 months, P=0.02 , and 6 months, P=0.04 ), but no significant difference in late postoperative pain visual analog scale scores. Conclusion: Both techniques are effective in the management of grade 3 or 4 hemorrhoidal disease, but DHL technique has less postoperative pain.