Doppler-Guided Hemorrhoidal Artery Ligation

Abstract

BACKGROUND: Doppler-guided hemorrhoidal artery ligation is a minimally invasive technique for the treatment of symptomatic hemorrhoids that has been applied successfully for grade II and III hemorrhoids but is less effective for grade IV hemorrhoids. OBJECTIVE: The evaluation of Doppler-guided hemorrhoid artery ligation as operative treatment option for the treatment of hemorrhoids. DESIGN: Prospective observational study. SETTING: Ain-shams University hospitals. PATIENTS: Thirty consecutive patients with grade II and III hemorrhoids treated from February 2012 to June 2014. INTERVENTION: Hemorrhoidal artery ligation. MAIN OUTCOME MEASURES: Operating time, number of ligations, and postoperative symptoms were recorded. Pain was graded on a visual analog scale. Follow-up was at one week, 1, 3, 6 and 12 months after surgery. RESULTS: A total of 30 consecutive patients (12 women, 18 men) with grade II and III hemorrhoids were included. Preoperative Symptoms were fresh bleeding related to defecation (90%), prolapse (100%), prurities (17%) and discharge (10%). The mean operative time was 30.0 min. ±14. Minutes (range, 20-40) minutes, with a mean of 8 (range, 6-10) ligations placed per patient. COMPLICATIONS: Intraoperative bleeding in 2 patients, 12 patients developed postoperative complications: One case of Postoperative bleeding, One case of Postoperative discharge, urine retention of 9 patients. Recurrence was observed in 1 patient (3%), hospital stay was mean ± SD = 28.8 h. ± 8.4h, (range 24-36 hours), with a mean follow-up of 11 (range, 6-16) months. CONCLUSION: Doppler-guided hemorrhoidal artery ligation is safe, easy to perform, and should be considered as an effective operative option for the treatment of grade II and III hemorrhoids. ________________________ Keywords: Doppler-guided Hemorrhoidal artery ligation (DGHAL) = Non-Excisional Hemorrhidectomy = Transanal Hemorrhoidal Dearterlization = hemorrhoidal artery ligation under control of Doppler.