Doppler Ultrasonografi Yardımlı Hemoroidal Arter Ligasyonu (DGHAL)
Özet
Doppler ultrasonografi yardımlı hemoroidal arter ligasyonu (DG-HAL), hemoroidal hastalığın tedavisinde ameliyat sonrası ağrıyı azaltmak ve hastaların iş hayatına erken dönmesini sağlamak amacıyla geliştirilmiş, ligasyon temelli, minimal invaziv bir cerrahi yöntemdir. İlk kez 1995 yılında tanımlanan bu teknik, özel bir proktoskop ve gömülü doppler ultrason probu kullanılarak süperior hemoroidal arterin Z sütür ile bağlanması esasına dayanır. Genellikle evre 2 ve 3 hemoroidal hastalıklarda tercih edilen bu yönteme, özellikle ileri evrelerde (evre 3 ve 4) sarkan hemoroid paketlerini düzeltmek için rekto-anal onarım (RAR) tekniği de eklenebilmektedir. RAR aşamasında mukozal iskemiyi önlemek adına sütürler arasında en az 5 mm mesafe bırakılması kritik önem taşır. Konvansiyonel cerrahi yöntemlerle karşılaştırıldığında DG-HAL; postoperatif ağrının azlığı, operasyon süresinin kısalığı, anorektal anatomik yapının korunması ve istirahat anal basıncının devamlılığı sayesinde inkontinans riskinin düşük olması gibi önemli avantajlar sunar. Uzun dönem nüks oranları açısından geleneksel yöntemlerle benzer veya daha başarılı sonuçlar bildirilmiştir. Yöntemin en belirgin dezavantajı ise operasyon sırasında kullanılan teknik ekipmanların maliyetli olmasıdır.
Doppler-guided hemorrhoidal artery ligation (DG-HAL) is a ligation-based, minimally invasive surgical procedure developed for hemorrhoidal disease treatment to minimize postoperative pain and facilitate an early return to daily activities. First described in 1995, the technique relies on utilizing a specialized proktoscope equipped with a Doppler ultrasound probe to precisely locate and ligate the superior hemorrhoidal artery using a Z-suture. Primarily indicated for grade 2 and 3 hemorrhoids, the procedure can be combined with the recto-anal repair (RAR) technique, particularly in advanced stages (grades 3 and 4), to address prolapsed hemorrhoidal cushions. During the RAR phase, maintaining a minimum distance of 5 mm between sutures is critical to prevent mucosal ischemia. Compared to conventional hemorrhoidectomy, DG-HAL offers distinct advantages, including reduced postoperative pain, shorter operative duration, preservation of natural anorectalc anatomy, and a minimized risk of postoperative incontinence by maintaining resting anal pressure. Long-term symptomatic recurrence rates are reported to be comparable to or lower than conventional methods. The primary disadvantage of this technique remains the high cost of the required specialized equipment.
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