DOPPLER-GUIDED TRANSANAL HEMORRHOIDAL DEARTERIALIZATION VERSUS DIGITAL PALPATION-GUIDED: A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction Transanal hemorrhoidal dearterialization (THD) is a widely used method for treating hemorrhoidal disease (HD). However, there is no consensus on the potential benefit of using Doppler ultrasound—a more costly technology—for identifying the arteries to be ligated.

Objectives To compare Doppler-guided THD versus digital palpation-guided THD in postoperative outcomes through a systematic review and meta-analysis.

Methods A systematic review of randomized clinical trials comparing patients undergoing THD with and without the use of Doppler was performed. Searches were conducted in PUBMED, Embase, and Cochrane databases on 04/22/2024. The outcomes analyzed were postoperative pain (1st to 7th postoperative day), prolapse (after 12 months), bleeding (after 6 months), operative time, and patient-reported satisfaction. Statistical analysis was conducted using RevMan Web from the Cochrane Library, with calculations expressed as mean difference (MD), standardized mean difference (SMD), and odds ratio (OR).

Results A total of 966 patients from 10 randomized clinical trials were included, comparing outcomes in patients undergoing arterial ligation with or without Doppler for the treatment of grade I-IV hemorrhoids according to the Goligher scale, with follow-up ranging from 6 months to 3 years. Bleeding at 6 months showed no significant difference between the use of Doppler and digital palpation (OR 1.38; 95% CI 0.68–2.79; P = 0.62; I² = 0%). Similarly, prolapse recurrence at one year showed no significant difference (OR 1.60; 95% CI 0.62–4.13; P = 0.08; I² = 52%) nor did postoperative pain (MD 1.10; 95% CI -0.33–2.52; P = 0.13; I² = 86%). Finally, operative time also did not reveal any statistically significant difference between the techniques (MD 3.87; 95% CI -18.94–26.67; P = 0.74; I² = 99%).

Conclusion Our findings demonstrate no significant difference between digital palpation-guided THD and Doppler-guided THD in terms of postoperative bleeding, prolapse recurrence, and operative time. These results suggest that equivalent efficacy can be achieved with lower-cost treatments, broadening the accessibility of surgical approaches using these techniques.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025