Clinical Outcomes in Patients with Hemorrhoids Treated by Finger Guided Hemorrhoidal Artery Ligation with Laser Hemorrhoidoplasty: A Retrospective Cohort Study

Abstract

Background: Hemorrhoids are the most common anorectal disease. In Finger guided Hemorrhoidal Artery Ligation (FGHAL), the branches of Superior Hemorrhoidal Artery (SHA) are ligated after palpating the arteries with finger 2-3 cm above dentate line instead of using a doppler as in Doppler-guided Hemorrhoidal Artery Ligation (DGHAL). The procedure is followed by Laser Hemorrhoidoplasty (LHP), a minimally invasive technique. Methods: We conducted the study to retrospectively analyze the clinical outcomes of FGHAL with LHP for surgical management in a patient cohort with hemorrhoids in routine clinical practice. We retrospectively collected and analyzed the data from hospital records of patients treated with FGHAL with LHP for their hemorrhoid disease (HD) from March 2017– March 2020 to understand the impact on pain, bleeding, and resolution of symptoms. Results: The study included a total of 346 patients within 27 to 75 years of age. The presenting features were bleeding (93%), pain (89%), and prolapsed hemorrhoids (69%). Most patients had grade II hemorrhoids (60.7%). Patients reported no spontaneous bleeding after surgery; 225 patients (65%) experienced post-defecatory bleeding the day one after surgery and 98 patients (28.3%) on postoperative day 3. Patients did not report any bleeding after the 7th postoperative day. 90.2% had completely resolved symptoms 6-months after surgery. The average VAS score at 6h,12h,24h,48h and 72h after surgery were 3,2.2,1.3,0.4 and 0.1 respectively. Conclusion: FGHAL is a cost-effective alternative to DGHAL. FGHAL, followed by the LHP technique, provides a very low pain and discomfort with minimal need for analgesics and wound care, electing it among the procedures suitable for HD. The method is a cost-effective alternative to DGHAL.