Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy
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To the Editor—We enjoyed reading the article by Felice et al.1 We performed a total of 188 hemorrhoidal artery ligation (HAL) procedures from 2001 until August 2004. Results at 6 to 12 weeks postoperatively were promising (improvement in 170/183 patients (93 percent)). However, when we analyzed patients at one year postoperatively, the results were disappointing. More than 25 percent needed another therapy for their hemorrhoids. Only 36 percent (32/88 patients with follow-up of 12 months or more) stated that the operation (still) had a positive effect on their symptoms. Of course, we tried to find out why the results were so disappointing in the long-term compared with those published:
Morinaga et al.2 had a follow-up of one month postoperatively.
Meintjes’ results3 were published on commercial internet sites but were never published in peer-reviewed journals. His follow-up was 5 to 24 months. Sohn et al.4 had a follow-up of 5 to 12 months. Ramirez et al.5 had a failure rate of 21 p ...
- Felice, G, Privitera, A, Ellul, E, Klaumann, M (2005) Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 48: pp. 2090-2093 CrossRef
- Morinaga, K, Hasuda, K, Ikeda, T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flow meter. Am J Gastroenterol 90: pp. 610-613
- Meintjes D. Doppler guided hemorrhoidal artery ligation (HAL) for the treatment of hemorrhoids. Results in 1415 patients. Patients studies 2000. Available at: www.pharma.it/eng/pati.htm and www.cjmedical.com/haemorrhoids/clinicalstudies.htm. Accessed 21 April 2006.
- Sohn, N, Aronoff, JS, Cohen, FS, Weinstein, MA (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182: pp. 515-519 CrossRef
- Ramirez, JM, Aguilella, V, Elia, M, Garcia, JA, Martinez, M (2005) Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Rev Esp Enferm Dig 97: pp. 97-103
- Aigner, F, Bodner, G, Conrad, F, Mbaka, A, Fritsch, H (2004) The superior rectal artery and its branches with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 187: pp. 102-108 CrossRef
- Jensen, SL, Harling, H, Arseth-Hansen, P, Tange, G (1989) The natural history of symptomatic haemorrhoids. Int J Colorectal Dis 4: pp. 41-44 CrossRef
- Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy
Diseases of the Colon & Rectum
Volume 49, Issue 7 , pp 1082-1083
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