Doppler guided haemorrhoidal artery ligation in the management of symptomatic hemorrhoids.

Abstract

Haemorrhoidal disease is the most common disease of the rectum. Usually, patients do not seek early treatment given the nature of the disease but the prevalence is estimated to range between 4.4% and 36.4%. Approximately 10-20% of patients will require surgery. Hemorrhoids are a physiological plexus of veins located between the lamina muscularis mucosa and sphincter muscle structures and consists of a superior (inner) and inferior (external) part divided by the dentate line. Because of arterial shunts and an extension of veins, this plexus becomes enlarged and plays an important role in “fine continence” of the anal canal. Today, haemorrhoidal disease is considered as a typical “civilization” disease, and nutrition, hygiene, and constitution, plays an important role in its development. The main pathogenic cause for haemorrhoidal disease is increased intraluminal blood pressure of the distal rectum. This results in an imbalance between arterial inflow and venous return. Reasons for the increase in intraluminal blood pressure are multifactorial and most probably individually different. Fiber free food, high tonus rates of the sphincter apparatus, stress and anatomic, physiologic and hereditary factors are currently considered possible causes. Enlargement and displacement of hemorrhoids typically presents with symptoms such as bleeding, pruritus, prolapse, sensation of incomplete evacuation, soiling, recurrent thrombosis of piles, etc. (which are bothersome and difficult to attenuate). However, the grade of prolapse and haemorrhoidal symptoms are often poorly correlated.