, Volume 49, Issue 7, pp 1082-1083
Date: 11 May 2006

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:

  1. Morinaga et al.2 had a follow-up of one month postoperatively.

  2. 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 ...