Haemorrhoids: haemorrhoidal artery ligation

Overview

General background | Focus of the review | Comments on evidence | Search and appraisal summary | Substantive changes at this update | Abstract | Cite as

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General background

Haemorrhoids are common in the general population. For people needing treatment there are a range of options available, although eventual choice of treatment will be based on a number of individual and operative factors.

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Focus of the review

In previous versions of this overview we evaluated the evidence for a broad range of interventions for haemorrhoids, including closed haemorrhoidectomy, infrared coagulation/photocoagulation, injection sclerotherapy, open excisional (Milligan-Morgan) haemorrhoidectomy, radiofrequency ablation, rubber band ligation, and stapled haemorrhoidectomy. Haemorrhoidal artery ligation (HAL; also known as transanal haemorrhoidal de-arterialisation) has grown in popularity since the last overview. For this update, we have, therefore, focused on the evidence for the effectiveness of HAL and how it compares to other selected surgical and non-surgical interventions for haemorrhoids.

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Comments on evidence

We found no RCTs comparing HAL with injection sclerotherapy, infrared coagulation, rubber band ligation, or radiofrequency ablation. We found one systematic review and three subsequent RCTs comparing HAL with stapled haemorrhoidectomy; two RCTs comparing HAL with closed haemorrhoidectomy; and two RCTs of HAL versus open excisional (Milligan-Morgan) haemorrhoidectomy. Overall, the quality of the evidence ranged from moderate to very low.

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Search and appraisal summary

The update literature search for this overview was carried out from the date of the last search, May 2008, to October 2014. For more information on the electronic databases searched and criteria applied during assessment of studies for potential relevance to the overview, please see the Methods section. Searching of electronic databases retrieved 150 studies. After deduplication and removal of conference abstracts, 70 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 46 studies and the further review of 24 full publications. Of the 24 full articles evaluated, one systematic review and seven RCTs were added at this update. In addition, one systematic review published after the search date of this overview was added to the Comment section.

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Substantive changes at this update

Haemorrhoidal artery ligation versus closed haemorrhoidectomy New option. Two RCTs added.[5][6] Categorised as 'trade-off between benefits and harms'.

Haemorrhoidal artery ligation versus injection sclerotherapy New option. No systematic reviews or RCTs added. Categorised as 'unknown effectiveness'.

Haemorrhoidal artery ligation versus infrared coagulation New option. No systematic reviews or RCTs added. Categorised as 'unknown effectiveness'.

Haemorrhoidal artery ligation versus open excisional (Milligan-Morgan) haemorrhoidectomy New option. Two RCTs added.[8][9] Categorised as 'trade-off between benefits and harms'.

Haemorrhoidal artery ligation versus radiofrequency ablation New option. No systematic reviews or RCTs added. Categorised as 'unknown effectiveness'.

Haemorrhoidal artery ligation versus rubber band ligation New option. No systematic reviews or RCTs added. Categorised as 'unknown effectiveness'.

Haemorrhoidal artery ligation versus stapled haemorrhoidectomy New option. One systematic review[10] and three RCTs[11][12][13] added. Categorised as 'trade-off between benefits and harms'.

Abstract

INTRODUCTION: Haemorrhoids are cushions of submucosal vascular tissue located in the anal canal starting just proximal to the dentate line. Haemorrhoids are a common condition. The incidence is difficult to ascertain as many people with the condition will never consult a medical practitioner. METHODS AND OUTCOMES: We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of haemorrhoidal artery ligation for haemorrhoidal disease? We searched: Medline, Embase, The Cochrane Library, and other important databases up to October 2014 (BMJ Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS: At this update, searching of electronic databases retrieved 150 studies. After deduplication and removal of conference abstracts, 70 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 46 studies and the further review of 24 full publications. Of the 24 full articles evaluated, one systematic review and seven RCTs were added at this update. We performed a GRADE evaluation for 11 PICO combinations. CONCLUSIONS: In this systematic overview, we categorised the efficacy for seven comparisons, based on information about the effectiveness and safety of haemorrhoidal artery ligation versus closed haemorrhoidectomy, injection sclerotherapy, infrared coagulation, open excisional (Milligan-Morgan) haemorrhoidectomy, radiofrequency ablation, rubber band ligation, and stapled haemorrhoidectomy.

Cite as

von Roon AC, Reese GE, Tekkis PP. Haemorrhoids: haemorrhoidal artery ligation. Systematic review 415. BMJ Clinical Evidence. . 2009 January. Accessed [date].

Latest citations

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