DG-RAR (Doppler-guided recto-anal repair): a new mini invasive technique in the treatment of prolapsed hemorrhoids (grade III-IV): preliminary report.

We present preliminary data from a prospective observational study on an initial group of 40 patients, selected from our Department, affected by grade III-IV hemorrhoids and treated with a new less invasive technique called Doppler-guided recto-anal repair [DG-RAR; Agency for Medical Innovations GmbH (AMI), Feldkirch, Osterreich, Austria]. This study was performed by analyzing bleeding, pain, and prolapse in the preoperative period and after surgery. Follow-up ranged from 5 to 37 months. We used this technique to treat the "vascular factor" with a Doppler-guided suture of the terminal branches of the hemorrhoidal arteries (HAL Doppler), and then we reduced hemorrhoidal prolapse [recto-anal repair (RAR)]. Recto-anal repair was performed with a special proctoscope with an oblique slot that when rotating shows a progressively wider portion of anorectal mucosa and submucosa in a longitudinal direction. Furthermore, this rotation enables the performance of a longitudinal pexy where the prolapse is located. The result is an immediate reduction of hemorrhoidal prolapse. Postoperative follow-up showed disappearance of pain and no bleeding. Relapse of prolapse occurred in 2 (5%) patients. Complications included 2 rectal impactions and 2 cases of thrombosis. The data appear encouraging for grade III-IV hemorrhoids treated with DG-RAR because of reduced trauma and a lower rate of complications with respect to other techniques used for prolapse reduction.