Outcome of Recto Anal Repair (RAR) without Doppler Transducer for Symptomatic Grade II, III and IV Internal Haemorrhoids

Abstract

Background: Haemorrhoidal illness causes around 4% of illness around the world. Internal haemorrhoids are painful and need surgical correction. Haemorrhoidectomy involves excision of haemorrhoidal tissue through transfixion of the arterial supply. Objective: To assess the outcome of recto-anal repair without doppler transducer for the treatment of grade II, III and IV internal hemorrhoids. Methods: This descriptive case series was conducted at Ghurki trust teaching hospital, Lahore, Pakistan, between January 2016 to December 2021. Using a convenience sampling technique, 100 patients who attended the outpatient department of the hospital were recruited for this study. These patients presented in the Outpatients Department with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention was conducted in the form of recto-anal repair without doppler transducer at the three primary sites of internal haemorrhoids in all patients and outcome was measured in terms of mean operating time, length of hospital stay, post-operative pain score, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. Results: Amongst the study sample, 60% patients were male and 40% were female. The mean age of the patients was 45 years and the mean operating time was 39 minutes. The mean duration of hospital stay was 26 hours. The mean postoperative pain score calculated by visual analogue scale (VAS), twenty-four hours after the surgery was 2.54. Six patients complained of excessive pain persisting for one week, two patients developed anal fissures with bleeding after the procedure. Long term follow-up spanning over one year, showed recurrence of prolapse in one patient. No patient suffered from wound infection, anal stenosis and fecal incontinence due to anal sphincter dysfunction. Conclusion: Recto-anal repair without doppler transducer is an effective method for the treatment of grades-II, III and IV internal haemorrhoids, with very low post-operative pain scores, good relief of symptoms and low recurrence rates. The added advantage is a very low cost because the doppler probe is not required.