Doppler‑guided hemorrhoidal artery ligation with recto‑anal repair versus Milligan Morgan hemorrhoidectomy for grade IV hemorrhoids

Background: Milligan Morgan (MM) hemorrhoidectomy is associated with significant postoperative pain and late return to daily activities. Doppler‑guided hemorrhoid artery ligation with recto‑anal repair (DG‑HAL with RAR) is a minimal‑invasive surgical treatment for hemorrhoids that has been used as an alternative method in order to reduce these inconveniences. Objective: The aim of this study was to compare the results of the two procedures in the management of grade IV hemorrhoids. Methods: This prospective, randomized, clinical study was carried out between June 2011 and June 2015. It included 126 patients with grade IV hemorrhoids, who were divided into two equal groups: group A, in which 63 patients were operated for DG‑HAL with RAR; and group B, in which 63 patients were operated for MM hemorrhoidectomy. Patients were evaluated preoperatively and postoperatively at 1 week, 1 month, 6 months, and 1 year. The follow‑up period was 1 year. Results: The mean age was higher in group A patients (P = 0.003). The operative time was significantly longer in group A (P 0.001). The first defecation occurred sooner in group A (P = 0.006) than in group B. The mean hospital stay was significantly shorter in group A (P 0.001). Moreover, the return to work was achieved significantly earlier in group A (P 0.001). The postoperative pain score (visual analog scale) was significantly less in group A patients, especially during defecation (P 0.001). The postoperative consumption of class II and III analgesics was significantly less in group A than in group B (P 0.005). After 1 year of follow‑up, there were no significant differences between the two groups as regards postoperative complications, recurrent prolapse, anorectal function, and fecal continence. Conclusion: DG‑HAL with RAR is an effective minimal‑invasive procedure with results comparable to MM hemorrhoidectomy for the treatment of grade IV hemorrhoids with fewer complications, less postoperative pain, shorter hospital stay, and earlier return to work.