OBJECTIVES

: Doppler-guided hemorrhoid artery ligation with rectoanal repair (DG-HAL-RAR) has experienced wider uptake and has recently received Republican Center for Healthcare Development approval in the Kazakhstan. A systematic review of the literature was conducted to assess its safety and efficacy.

METHODS

: In this systematic review is MEDLINE, EMBASE, TRIPDATABASE and Cochrane Library databases were searched. Studies describing DG-HAL-RAR as a primary procedure and reporting clinical outcome were considered. Primary end-points were recurrence and postoperative pain. Secondary end-points included operation time, complications and reintervention rates. Studies were scored for quality with either Jadad score.

RESULTS

: Results 31 studies including 32409 patients were included in the final analysis. They were of poor overall quality. Median follow-up was 26 (12-36) months. 77.5% of patients confirmed complete relief of symptoms after 30 days and 82.5% of patients feel free of symptoms 6 months after the procedure. Recurrence ranged between 3% and 61%(pooled recurrence rate 17.5%), with the highest rates for grade IV haemorrhoids. Postoperative analgesia was required in 0–40% of patients. Overall postoperative complication rates were low, with an overall bleeding rate of 6.3% and an overall reintervention rate of 7.1%.

CONCLUSIONS

: DG-HAL-RAR is safe and almost painless technique and it has very good results in the control of haemorrhoidal symptoms. This procedure should be considered as an effective first treatment option for haemorrhoids, with fewer complications, less postoperative pain, shorter hospital stay, and earlier return to work. It can be safely considered for primary treatment of grade II and III haemorrhoids. There is a need for larger-scale randomized trials to establish the efficacy of DG-HAL_RAR. Future trials must also include inclusion of cost-effectiveness analysis.