Evaluation of Doppler-guided Hemorrhoid Artery Ligation and Recto anal Repair Procedure: A Single-center Analysis in Indonesia

A BSTRACT Context: Doppler-guided hemorrhoidal artery ligation-recto anal repair (DG HAL-RAR) is a minimally invasive alternative treatment with reported significantly less pain and minimal complication than the standardized conventional hemorrhoidectomy. Currently, there is a lack of study describing said procedure in Indonesia. Aims: This study aims to evaluate the efficacy and short-term complications of DG HAL-RAR in Indonesia in correlation to the presenting symptoms and degree of hemorrhoids. Settings and Design: A retrospective study was conducted on patients who underwent DG HAL-RAR procedure between November 2015 and August 2023 in Siloam Hospital Lippo Village. Methods: Data collected includes the patient’s preoperative symptoms, hemorrhoidal grading, and details of operative technique. Further details regarding hospital stay, such as postoperative pain and short-term complications were also noted. Statistical Analysis Used: Descriptive study. Results: A total of 499 patients who underwent DG HAL-RAR ranging from Golligher’s grade 1–4 were included in the study. Presenting symptoms were anal lump (94%), anal pain (74%), and hematochezia (63%). The mean operating time was 31 ± 11.3 min. The mean duration of hospital stay was 2 ± 1.1 days. A subsequent 1-week follow-up revealed hematochezia in 18% (90 patients), constipation in 3.4%, anal itchiness in 0.4%, postoperative swelling in 10.6%, and perianal pain in 43.1%. Conclusion: DG HAL-RAR is a safe and effective treatment for hemorrhoidal disease with minimal complications and short hospital stay. This surgical option could be used as a treatment option for all stages of internal hemorrhoids.