Skip to main content

Advertisement

SpringerLink
Log in

A new technique of doppler dearterialization for hemorrhoidal disease: arterial detection ligation (ADL)

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

We describe the arterial detection ligation (ADL) technique, designed to find arteries at time-appropriate depth for ligating, and report our preliminary results of using this technique to treat patients with the hemorrhoidal disease (HD).

Methods

The subjects of this retrospective analysis were patients with symptomatic grades 2 or 3 HD. We analyzed the clinical characteristics, postoperative complications, recurrence, and patient satisfaction of the patients treated with ADL.

Results

A total of 75 patients were included in the study (male/female ratio 1.88; mean age 48 ± 19 years; mean BMI 24 ± 3 kg/m2). Thirty-nine patients (52%) did not require hospitalization and were discharged from the day clinic approximately 4 h postoperatively. Four patients (5.3%) suffered tenesmus for about 1 week postoperatively and two (2.7%) suffered temporary rectal bleeding. The mean VAS scores 1 day postoperatively, then at 1 week, 1 month and 1 year were 2.9, 1.5, 0.4, and 0, respectively. At the 1-month follow-up, there was no sign of recurrence and the satisfaction rate was 78.6% (n = 59). At the 1-year follow-up, three patients (4%) had a recurrence and the satisfaction rate was 86.7% (n = 65).

Conclusion

Based on our preliminary findings, ADL is an effective technique for treating HD, generally as an outpatient procedure, without serious morbidity. We anticipate that the incidence of tenesmus, which is encountered frequently after other dearterialization methods, will be lower after the ADL technique, which avoids both mass ligation of hemorrhoidal arteries deeper than 12 mm and running a long mucopexy suture line.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

HD:

Hemorrhoidal disease

DGHAL:

Doppler-guided hemorrhoidal artery ligation

SRA:

Superior rectal artery

ADL:

Arterial Detection Ligation

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

VAS:

Visual Analogue Scale

References

  1. Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg. 2007;204:102–17.

    Article  Google Scholar 

  2. Gerjy R, Lindhoff-Larson A, Nystrom PO. Grade of prolapse and symptoms of haemorrhoids are poorly correlated: result of a classification algorithm in 270 patients. Colorectal Dis. 2008;10:694–700.

    Article  CAS  Google Scholar 

  3. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G. Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009;52:1665–71.

    Article  Google Scholar 

  4. Sohn N, Aronoff JS, Cohen FS, Weinstein MA. Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg. 2001;182:515–9.

    Article  CAS  Google Scholar 

  5. Tjandra JJ, Chan MK. Systematic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum. 2007;50:878–92.

    Article  Google Scholar 

  6. Aigner F, Bodner G, Conrad F, Mbaka G, Kreczy A, Fritsch H. The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg. 2004;187:102–8.

    Article  Google Scholar 

  7. Schuurman JP, Go PM, Bleys RL. Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis. 2009;11:967–71.

    Article  CAS  Google Scholar 

  8. Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol. 1995;90:610–3.

    CAS  PubMed  Google Scholar 

  9. Ratto C, Campenni P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017;21:953–62.

    Article  Google Scholar 

  10. Emile SH, Elfeki H, Sakr A, Shalaby M. Transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) in treatment of internal hemorrhoids: a systematic review and meta-analysis of randomized clinical trials. Int J Colorectal Dis. 2019;34:1–11.

    Article  Google Scholar 

  11. De Nardi P, Capretti G, Corsaro A, Staudacher C. A prospective, randomized trial comparing the short- and long-term results of doppler-guided transanal hemorrhoid dearterialization with mucopexy versus excision hemorrhoidectomy for grade III hemorrhoids. Dis Colon Rectum. 2014;57:348–53.

    Article  Google Scholar 

  12. Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol. 2014;18:291–8.

    Article  CAS  Google Scholar 

  13. Giordano P, Gravante G, Sorge R, Ovens L, Nastro P. Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg. 2009;144:266–72.

    Article  Google Scholar 

  14. Jayaraman S, Colquhoun PH, Malthaner RA. Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum. 2007;50:1297–305.

    Article  Google Scholar 

  15. Elmer SE, Nygren JO, Lenander CE. A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum. 2013;56:484–90.

    Article  Google Scholar 

  16. Dal Monte PP, Tagariello C, Sarago M, Giordano P, Shafi A, Cudazzo E, et al. Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol. 2007;11:333–8 ((discussion 8–9)).

    Article  Google Scholar 

  17. Ratto C, Parello A, Veronese E, Cudazzo E, D’Agostino E, Pagano C, et al. Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis. 2015;17:O10–9.

    CAS  PubMed  Google Scholar 

  18. Beliard A, Labbe F, de Faucal D, Fabreguette JM, Pouderoux P, Borie F. A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy. J Visc Surg. 2014;151:257–62.

    Article  CAS  Google Scholar 

  19. Venara A, Podevin J, Godeberge P, Redon Y, Barussaud ML, Sielezneff I, et al. A comparison of surgical devices for grade II and III hemorrhoidal disease. Results from the LigaLongo Trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy. Int J Colorectal Dis. 2018;33:1479–83.

    Article  Google Scholar 

  20. Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S. Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis. 2014;16:373–6.

    Article  CAS  Google Scholar 

  21. Jeong WJ, Cho SW, Noh KT, Chung SS. One year follow-up result of Doppler-guided hemorrhoidal artery ligation and recto-anal repair in 97 consecutive patients. J Korean Soc Coloproctol. 2011;27:298–302.

    Article  Google Scholar 

  22. Ratto C, Donisi L, Parello A, Litta F, Doglietto GB. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum. 2010;53:803–11.

    Article  Google Scholar 

  23. Rotta CM, Moraes FOD, Neto V, Fernandez A, Rotta TCA, Gregório JVAM, et al. Doppler-guided hemorrhoidal artery ligation with rectal mucopexy technique: initial evaluation of 42 cases. J Coloproctol (Rio de Janeiro). 2012;32:372–84.

    Article  Google Scholar 

  24. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y. Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum. 2011;54:226–31.

    Article  Google Scholar 

  25. Forrest NP, Mullerat J, Evans C, Middleton SB. Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids. Int J Colorectal Dis. 2010;25:1251–6.

    Article  Google Scholar 

  26. Walega P, Krokowicz P, Romaniszyn M, Kenig J, Salowka J, Nowakowski M, et al. Doppler guided haemorrhoidal arterial ligation with recto-anal-repair (RAR) for the treatment of advanced haemorrhoidal disease. Colorectal Dis. 2010;12:e326–9.

    Article  CAS  Google Scholar 

  27. LaBella GD, Main WP, Hussain LR. Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience. Tech Coloproctol. 2015;19:153–7.

    Article  CAS  Google Scholar 

  28. Giarratano G, Toscana E, Toscana C, Petrella G, Shalaby M, Sileri P. Transanal hemorrhoidal dearterialization versus stapled hemorrhoidopexy: long-term follow-up of a prospective randomized study. Surg Innov. 2018;25:236–41.

    Article  Google Scholar 

  29. Giordano P, Nastro P, Davies A, Gravante G. Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol. 2011;15:67–73.

    Article  CAS  Google Scholar 

  30. Venturi M, Salamina G, Vergani C. Stapled anopexy versus transanal hemorrhoidal dearterialization for hemorrhoidal disease: a three-year follow-up from a randomized study. Minerva Chir. 2016;71:365–71.

    PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Damla Sen and Emel Basol for the data collection.

Funding

No funding was received.

Author information

Authors and Affiliations

  1. Department of General Surgery, VKF American Hospital, Guzelbahce Street, No:20, Sisli, Istanbul, Turkey

    Serkan Zenger, Bulent Gurbuz, Ugur Can & Tunc Yalti

  2. Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey

    Tunc Yalti

Authors
  1. Serkan Zenger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bulent Gurbuz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ugur Can
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tunc Yalti
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SZ conceived and designed the report. SZ, BG, and UC participated in the acquisition of data. SZ, BG, and UC analyzed and interpreted the data. SZ drafted the manuscript. SZ and TY coordinated and critically revised the report. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Serkan Zenger.

Ethics declarations

Conflict of interest

We have no conflicts of interest to declare.

Ethical approval

The study protocol was approved by the Institutional Review Board of Koç University, School of Medicine (2020.068.IRB1.016).

Informed consent

Written informed consent was obtained from all patients.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zenger, S., Gurbuz, B., Can, U. et al. A new technique of doppler dearterialization for hemorrhoidal disease: arterial detection ligation (ADL). Surg Today 51, 612–618 (2021). https://doi.org/10.1007/s00595-020-02164-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-020-02164-7

Keywords

Search

Navigation