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
{"title":"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。","authors":"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","doi":"10.1111/ans.19258","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>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, <i>P</i> = 0.804) or post-operative bleeding (<i>P</i> = 0.142) between the two groups. DG HAL-RAR patients were more likely to have post-operative urinary retention (<i>P</i> < 0.001). Non-DG patients were less likely to experience recurrence (OR 5.12, <i>P</i> < 0.001).</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":"94 11","pages":"2053-2061"},"PeriodicalIF":1.5000,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Haemorrhoid artery ligation – recto anal repair (HAL-RAR) blind versus Doppler: a systematic review and meta-analysis\",\"authors\":\"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\",\"doi\":\"10.1111/ans.19258\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>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, <i>P</i> = 0.804) or post-operative bleeding (<i>P</i> = 0.142) between the two groups. DG HAL-RAR patients were more likely to have post-operative urinary retention (<i>P</i> < 0.001). Non-DG patients were less likely to experience recurrence (OR 5.12, <i>P</i> < 0.001).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Our review of non-DG HAL-RAR compared to DG HAL-RAR reflects the non-inferiority of the non-DG HALRAR procedure. 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Haemorrhoid artery ligation – recto anal repair (HAL-RAR) blind versus Doppler: a systematic review and meta-analysis
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.
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.
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