PURPOSE: The aim of this paper is to present 12-month follow-up results of functional evaluation and safety assessment of an innovative modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in the treatment of IIIrd and IVth grade hemorrhoidal disease (HD), conducted in the 3rd Department of General Surgery, Jagiellonian University. METHODS: A total of 38 patients with grade III and IV HD underwent the RAR procedure consisting of Doppler Guided Hemorrhoid Artery Ligation combined with restoration of the prolapsed hemorrhoids to their anatomical position with longitudinal continuous sutures. Each patient had a rectal examination, anorectal manometry and Quality of Life questionnaire performed before, 3 months, and 12 months after the RAR procedure. RESULTS: Of the initial 38 patients 18 were lost to follow-up. Among the remaining 20 patients, there were three cases (15%) of intraoperative and one (5%) of early postoperative bleeding. 3 months after RAR 5 cases of minor residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of some symptoms. 12 months after RAR another 3 cases of hemorrhoid disease recurrence were detected, to a total of 8 patients (40%) with minor HD recurrence 12 months after RAR. Anal pressure levels 3 months after RAR were significantly lower than before the procedure (p<0,05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR. CONCLUSIONS: RAR seems to be a safe method of treatment of IIIrd and IVth grade HD with no major complications. The procedure has a significant influence on resting and squeeze anal pressure, with no evidence of risk of fecal incontinence after the operation.
Program Number: P113