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Hämorrhoidalarterienligatur/Rektoanal-Repair nach der HubBLe-Studie

Wieso sollte dieses Verfahren noch angewendet werden?

Hemorrhoidal artery ligation and rectoanal repair according to the HubBLe study

Why should this procedure still be used?

  • Leitthema
  • Published:
coloproctology Aims and scope

Zusammenfassung

Die HubBLe-Studie hat dazu beigetragen, erneut über die Indikationen und Verfahrenswahl in der Hämorrhoidentherapie intensiv nachzudenken. Sie verglich die Gummibandligatur (GBL) mit der HAL-RAR-Methode (Hämorrhoidalarterienligatur und Rektoanal-Repair) bei niedriggradigen Hämorrhoiden bezüglich der Rezidivrate nach einem Jahr. Dabei kam sie zu dem Ergebnis, dass die Rezidivrate beim HAL-RAR-Verfahren zwar geringer war als bei einer einmaligen GBL, beim HAL-RAR jedoch mehr Schmerzen auftraten. Bei wiederholter GBL war die Rezidivrate zwischen beiden Verfahren nicht signifikant unterschiedlich. Daraus wurde geschlossen, dass sowohl Patienten aufgrund der höheren Invasivität als auch Gesundheitsbehörden aufgrund der deutlich höheren Kosten des HAL-RAR die Gummibandligatur bevorzugen. Die Studie zeigt das Klassifikationsproblem beim Hämorrhoidalleiden bei Anwendung der Goligher-Klassifikation. Es erfolgte die Behandlung von Low-grade-Hämorrhoiden 2. und 3. Grades. Während sich die GBL bei hoher Praktikabilität und guten Ergebnissen für Hämorrhoiden im Stadium 2 exzellent eignet, sind ihre Ergebnisse im Stadium 3 schlecht. Demgegenüber ist die Domäne des HAL-RAR-Verfahrens im Hämorrhoiden-Stadium 3 zu sehen und damit ein Vergleich beider Verfahren über 2 Stadien hinweg nicht sinnvoll. Aus diesem Grund kann die Schlussfolgerung der HubBLe-Studie bezüglich der Überlegenheit der GBL keinesfalls geteilt werden. Das HAL-RAR-Verfahren stellt eine wesentliche Ergänzung in der individuellen Therapie von Hämorrhoiden 3. Grades neben den konventionell resezierenden Verfahren und der Stapler-Hämorrhoidopexie dar. Trotz der vielen interessanten Ansatzpunkte der HubBLe-Studie gibt es keinen Grund, die HAL-RAR-Methode nicht weiterhin indikationsgerecht einzusetzen.

Abstract

The HubBLe study has contributed to a renewed intensive reflection on the indications and choice of procedures in the treatment of hemorrhoids. The study compared the rubber band ligation (RBL) with hemorroidal artery ligation and rectoanal repair (HAL-RAR) for low-grade hemorrhoids with respect to the recurrence rate after 1 year. The study came to the conclusion that although the recurrence rate with the HAL-RAR procedure was lower than with a single RBL, the HAL-RAR procedure was more painful. With repeated RBL the recurrence rate between the two procedures was not significantly different. From this it was concluded that the RBL procedure is preferred by patients due to the higher invasiveness and by health authorities due to the significantly higher costs of HAL-RAR. This study also showed the problems with the classification of hemorrhoidal disease using the Goligher classification. Low-grade hemorrhoids stage II and III were treated. While RBL is excellently suited for stage II hemorrhoids with high practicability and good results, the results in stage III are poor. In contrast, the domain of the HAL-RAR procedure is in stage III hemorrhoids and therefore a comparison of both procedures over two stages is not useful. For this reason, the conclusions of the HubBLe study regarding the superiority of the RBL cannot be shared in any way. The HAL-RAR procedure represents an essential supplement to the individual treatment of stage III hemorrhoids in addition to conventional resection procedures and stapled hemorrhoidopexy. In spite of the many interesting starting points of the HubBLe study there is no reason why the HAL-RAR method should not be used in accordance with appropriate indications.

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Author information

Authors and Affiliations

  1. Klinik für Viszeralchirurgie und Proktologie, Diakonissenkrankenhaus Dresden, Holzhofgasse 29, 01099, Dresden, Deutschland

    Th. Jacobi

  2. Klinik für Allgemein- und Viszeralchirurgie, Klinikum Mittleres Erzgebirge, Zschopau, Deutschland

    H.-U. Dorn

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Correspondence to Th. Jacobi.

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Interessenkonflikt

H.‑U. Dorn führt Workshops und Op Kurse zum HAL/ RAR Verfahren der Fa. AMI durch. T. Jacobi gibt an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Jacobi, T., Dorn, HU. Hämorrhoidalarterienligatur/Rektoanal-Repair nach der HubBLe-Studie. coloproctology 42, 18–23 (2020). https://doi.org/10.1007/s00053-019-00419-7

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