Modified Hemorrhoidal Artery Ligation Malang Procedure as an Alternative Therapy in Management of Haemorrhoid Grade III

Authors : Setyo Sugiharto Marsudji; Alfian Jalal P

Volume/Issue : Volume 6 - 2021, Issue 7 - July

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Background Surgical procedure in symptomatic hemorrhoid, either closed and open hemorrhoidectomy, always associate with long duration of high grade post operative pain, long time of recovery, and various post operative complication. Some new operation technique had been introduced to solve the problem above. The Doppler Guided Hemorrhoid Artery Ligation (DGHAL) technique had decreased the post operative pain successfully. In the developing countries, the limitation in using protoscope Doppler solved by some modification of DGHAL technique, known as Modified Hemorrhoid Artery Ligation (MHAL) that switch the use of hemorrhoid artery Doppler with palpation of artery pulsation in its anatomic location. In 2009, Association of Coloproctology of Great Britain and Ireland had recommended some surgeon to use a Hemorrhoid Artery Ligation technique without Doppler. In Saiful Anwar General Hospital Malang, one of the digestive surgeon, dr. Setyo S, SpB(KBD) had undergone some hemorrhoid surgical procedure using Modified Hemorrhoid Artery Ligation (MHAL) technique with satisfying result since 2008. Objective Observe the post operative pain, length of stay and resting period needed for the patient after undergo a Modified Hemorrhoid Artery Ligation procedure and chance of any complication after six week. Method Twenty patients diagnosed with internal hemorrhoid grade III undergo a surgical procedure with MHAL or Closed Hemorrhoidectomy Ferguson technique. Sample divided in two groups using Quasi experimental design. After procedure, the pain score a day after operation is recorded. The length of stay, resting period needed and complication after six week after operation had also been observed. Result There is a significant different result in post operative pain score (p=0,001), length of stay (p=0,001) and resting period needed (p=0,001) using MHAL technique comparing to the CHF technique. However, there is no significant difference in incidence of complication in six week post operation for both techniques. Conclusion The MHAL technique is better than CHF technique considering post operative pain, length of stay and resting period needed.

Keywords : Internal hemorrhoid grade III, Modified Hemorrhoid Artery Ligation (MHAL), closed hemorrhoidectomy Ferguson (CHF), post operative pain


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