Table 5.
Comparative trials comparing THD Doppler procedure with other techniques
| Study | No. patients, grade | Compared procedure | Outcome |
|---|---|---|---|
| Festen et al. [11] | Total: 23 Grade 3: 19 Grade 4: 4 |
PPH | No significant difference in complications. However, significantly shorter operative time for DGHL (23 vs. 34 min, p < 0.001) and less pain (pain score at day 7: 1.6 vs. 3.2, p < 0.01) |
| Giordano et al. [13] | Total: 28 Grade 2: 16 Grade 2: 12 |
PPH | No significant difference in pain, operative time, complications, or recurrence rate. Patients returned to normal activities faster after DGHL (3.2 vs. 6.3 days, p < 0.01) |
| Schuurman et al. [14] | Total: 38 (grades 2–3) | HL | No significant difference in patient-reported severity of bleeding, pain, defecation problems, and discomfort. Greater improvement in prolapse symptoms in non-Doppler group (p = 0.047). Higher rate of complications for DGHL (p < 0.0005) |
| Infantino et al. [15] | Total: 85 (grade 3) | PPH | No significant difference in pain, postoperative complications, recurrence, or reoperation rates. Higher rate of late complications for PPH (p = 0.028). Shorter length of stay and lower equipment cost for DGHL |
| Zampieriet al. [16] | Total: 46 Grade 3: 21 Grade 4: 25 |
Ligasure hemorrhoidectomy | In DGHL group, lower length of procedure (20 ± 5.1 vs. 28 ± 4.2 min, p < 0.05), higher pain resolution rate (87 vs. 81%, p < 0.05), better QoL, lower number of constipation days |
| Elmér et al. [19] | Total: 20 Grade 2: 3 Grade 3: 17 |
MMH | Postop peak pain lower in DGHL during first week (p < 0.05), but no difference in overall pain. More patients with normal well-being in DGHL (p = 0.05). Pain, bleeding, and manual reduction in prolapse improved in all DGHL pts. At 1-year follow-up, grade of hemorrhoids reduced for both methods (more patients with remaining grade II for DGHL (p = 0.06) |
| Denoya et al. [17] | Total: 20 Grade 3: 16 Grade 4: 4 |
Ferguson hemorrhoidectomy | In DGHL group, lower postop narcotics use (25 vs. 100%, p < 0.001), shorter postop analgesics use (0 vs. 7 days, p = 0.001), earlier first bowel movement (1.3 ± 0.9 vs. 4.6 ± 3.1 days, p = 0.001), lower pain intensity rate (2.9 ± 3.5 vs. 7.6 ± 2.9, p = 0.001), less frequent urinary retention (0 vs. 23.5%, p = 0.012), less laxative use (8.3 vs. 23.5%, p = 175), less anal pain (8.3 vs. 64.7%, p = 0.001) |
| Denoya et al. [18] | Total: 12 | Ferguson hemorrhoidectomy | In DGHL group, similar recurrence rate (16.7 vs. 6.7%, p = 0.411), reintervention rate (8.3 vs. 6,7%, p = 809), no chronic complications (0 vs. 13.3%, p = 0.189), similar rate of recurrent symptoms (50 vs. 26.7%, p = 0.212), similar pain severity, similar QoL, similar incontinence-related QoL |
| De Nardi et al. [20] | Total: 25 (grade 3) | MMH | Similar pain level by 30th postop day. In DGH, shorter work resumption and higher patient satisfaction, but not significantly. Similar recurrence rates needing additional surgery (4.2 vs. 4.2%, p = 0.55) at 1-year follow-up |
| Béliard et al. [23] | Total: 54 (grade 2) | PPH | In DGHL group, shorter disability for work (4.4 ± 6.6 vs. 18.6 ± 13.7, p < 0.001), significantly more improved prolapse, similar improvement of bleeding, significant improvement of tenesmus at 3 months, similar incontinence score, lower pain level at 1 month, significantly higher patient satisfaction, higher recurrence rate, similar reoperation rate |
PPH procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy); HL hemorrhoidal artery ligation (without Doppler guidance); DGHL Doppler-guided hemorrhoidal artery ligation; MMH Milligan–Morgan hemorrhoidectomy; QoL quality of life