Ulus Travma Acil Cerrahi Derg. Ahead of Print: UTD-79406 | DOI: 10.14744/tjtes.2024.79406

Emborrhoid Technique in Hemorrhoidal Disease: Retrospective Analysis of Data from a Single Center

Ahmet Baþ¹, Ahmet Üstündað¹, Sefa Ergün², Cesur Samancý¹, Süleyman Demiryas^2
1Department of Radiology, Ýstanbul University-Cerrahpaþa, Cerrahpaþa Faculty of Medicine, Ýstanbul, Türkiye
²Department of General Surgery, i̇stanbul University-Cerrahpaþa, Cerrahpaþa Faculty of Medicine, Ýstanbul, Türkiye

OBJECTÝVE
This study evaluates the safety and effectiveness of coil embolization of the superior rectal artery for both emergency and elective treatment of rectal bleeding caused by Goligher grade 4 hemorrhoids, where surgery is contraindicated.
MATERÝALS AND METHODS
Between 2019 and 2024, 18 patients (11 males, 7 females) with a mean age of 65±10.3 years were included in the study. Hemorrhoid grading was performed according to the Goligher classification, and rectal bleeding grading was performed according to the Paris bleeding severity score. Femoral artery access was used for embolization in all patients, and superior rectal artery branches were embolized only with coils. All patients were treated electively, except one who developed hemodynamic instability due to massive rectal bleeding while monitored in the intensive care unit. Follow-up was performed by clinical examination and rectoscopy at 1, 3, and 6 months.
RESULTS
All patients were treated with 100% technical success. No procedure-related ischemic complications were observed, and no femoral artery puncture-related complications were observed in any patient. All patients were grade 4 according to the Goligher classification before treatment. The mean Paris bleeding severity score was 6.6±1.1 before treatment, 3.4±1.5 in the first month, 3.8±1.61 in the third month, and 3.6±1.29 in the sixth month. One patient had a recurrence in the first month and one patient in the third month. Clinical success was 95% in the first month and 85% in the third and sixth months. Re-embolization was not performed in patients with recurrence.
CONCLUSÝON
In conclusion, this study has demonstrated that coil embolization of superior rectal artery branches is a safe and effective minimally invasive procedure for both the emergency treatment of bleeding due to grade-4 hemorrhoidal disease and the elective treatment of patients who are not suitable for surgical treatment.

Keywords: Hemorrhoidal Disease, superior rectal artery embolization, Emborrhoid technique, Emergency treatment of active rectal bleeding

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Hemoroidal Hastalýkta Emboroid Tekniði: Tek Merkeze Ait Verilerin Retrospektif Analizi

Ahmet Baþ¹, Ahmet Üstündað¹, Sefa Ergün², Cesur Samancý¹, Süleyman Demiryas^2
1Radyoloji Anabilim Dalý, Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Ýstanbul, Türkiye
²Genel Cerrahi Anabilim Dalý, Ýstanbul Üniversitesi-Cerrahpaþa, Cerrahpaþa Týp Fakültesi, Ýstanbul, Türkiye

AMAÇ
Bu çalýþmanýn amacý cerrahinin kontrendike olduðu Goligher grade 4 hemoroide baðlý rektal kanamanýn acil ve elektif tedavisinde süperior rektal arterin koil embolizasyonunun güvenilirliðini ve etkinliðini deðerlendirmektir.
GEREÇ VE YÖNTEM
2019-2024 yýllarý arasýnda yaþ ortalamalarý 65±10.3 olan 18 hasta ( 11 erkek, 7 kadýn) çalýþmaya alýndý.Hemoroid derecelendirmesi Goligher sýnýflamasýna göre, rektal kanama derecelendirmesi ise Paris kanama þiddeti skoruna göre yapýlmýþtýr. Tüm hastalarda embolizasyon için femoral arter giriþi yapýlmýþtýr ve süperior rektal arter dallarý yalnýzca koiller ile embolize edilmiþtir. Yoðun bakým ünitesinde takip sýrasýnda masif rektal kanama nedeniyle hemodinamik instabilite geliþen bir hasta dýþýnda tüm hastalar elektif olarak tedavi edildi.Takipler 1., 3., ve 6.ayda klinik muayene ve rektoskopi ile yapýlmýþtýr.
BULGULAR
Hastalarýn tamamý %100 teknik baþarý ile tedavi edildi. Ýþleme baðlý herhangi bir iskemik komplikasyon izlenmedi ve hiçbir hastada femoral arter ponksiyonuyla ilgili komplikasyon gözlenmedi. Tedavi öncesinde Goligher sýnýflamasýna göre tüm hastalar grade-4 olarak tespit edilmiþtir. Paris kanama þiddeti skoru tedavi öncesi ortalama 6.6±1.1 olup 1. ayda bu skor 3.4±1.5, 3.ayda 3.6±1.29 ve 6.ayda 3.6±1.29 olarak bulunmuþtur.1 hastada 1. ayda ve 1 hastada 3. ayda nüks görüldü. 1.ayda klinik baþarý %95,3.ay ve 6.ay kontrolleri sonrasý %85 olarak bulunmuþtur. Nüks görülen hastalara re-embolizasyon yapýlmadý.
SONUÇ
Sonuç olarak, bu çalýþma grade-4 hemoroidal hastalýða baðlý kanamanýn hem acil tedavisinde ve hem de cerrahi tedaviye uygun olmayan hastalarýn elektif tedavisinde süperior rektal arter dallarýnýn koil embolizasyonunun güvenli ve etkili minimal invaziv bir prosedür olduðunu göstermiþtir.

Anahtar Kelimeler: Hemoroidal hastalýk, süperior rektal arter embolizasyonu, emboroid tekniði, aktif rektal kanamanýn acil tedavisi

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