Techniques in Coloproctology

, Volume 15, Issue 4, pp 439–444 | Cite as

Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids

  • P. J. Gupta
  • S. Kalaskar
  • S. Taori
  • P. S. Heda
Original Article



Doppler-guided ligation of hemorrhoidal vessels is being proposed as a treatment of grade 2 and 3 hemorrhoids. Many researchers are coupling this procedure with mucopexy or lifting of hemorrhoids to control the prolapse more effectively. The present study was conducted in patients with 3rd-degree hemorrhoids to determine the usefulness of Doppler-guided hemorrhoidal artery ligation compared to mucopexy of prolapsing hemorrhoids and to compare it with mere mucopexy of the hemorrhoids.

Materials and methods

A double-blind, randomized controlled study was conducted on 48 consecutive patients with grade III hemorrhoids requiring surgery. The patients were randomized into two groups. Half of them were treated with ligation and mucopexy [SL], while the remaining patients underwent a Doppler-guided hemorrhoidal artery ligation followed by ligation and mucopexy [DSL]. The patients were examined by a blinded independent observer at 2, 4, and 6 weeks and at the end of 1 year after the operation to evaluate postoperative pain scores, amount of analgesics consumed, and complications encountered. The observer also assessed recurrence of hemorrhoids after 1 year.


Operative time was significantly longer in the DSL group (31 min vs. 9 min P < 0.003). The postoperative pain score was significantly higher in the Doppler group [4.4 vs. 2.2, P < 0.002 (visual analogue scale)]. The mean total analgesic dose and duration of pain control using analgesics were greater and longer for the Doppler group than for the SL group (17 vs. 11 tablets, and 13 days vs. 9 days, respectively; P < 0. 01). Complications were similar in both the groups. At 1-year follow-up, the recurrence of hemorrhoids was not statistically significant in either group (4 patients in SL group and 3 patients in DSL group; P < 0.93).


Suture ligation of hemorrhoids is a simple, cost-effective, and convenient modality for treating grade 3 hemorrhoids. Doppler assistance in ligating the hemorrhoidal vessels prior to hemorrhoidal mucopexy offers no advantage and is a time-consuming procedure.


Hemorrhoids Ligation Doppler Suture Pain 



Neither sponsorship nor financial support of any kind was received for the study.

Conflict of interest

No conflict of interest.


  1. 1.
    Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52:1665–1671PubMedCrossRefGoogle Scholar
  2. 2.
    Szmulowicz UM, Gurland B, Garofalo T, Zutshi M (2011) Doppler-guided hemorrhoidal artery ligation: The experience of a single institution. J Gastrointest Surg 15:803–808PubMedCrossRefGoogle Scholar
  3. 3.
    Pol RA, van der Zwet WC, Hoornenborg D et al (2010) Results of 244 consecutive patients with hemorrhoids treated with Doppler-guided hemorrhoidal artery ligation. Dig Surg 27:279–284PubMedCrossRefGoogle Scholar
  4. 4.
    Forrest NP, Mullerat J, Evans C, Middleton SB (2010) Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids. Int J Colorectal Dis 25:1251–1256PubMedCrossRefGoogle Scholar
  5. 5.
    Zagriadskiĭ EA, Gorelov SI (2008) Transanal doppler-guided hemorrhoidal artery ligation/recto anal repair (HAL-RAR®) for treatment of Grade 3–4 hemorrhoids: a new mini-invasive technology. Pelviperineology 27:151–155Google Scholar
  6. 6.
    Satzinger U, Fiel W, Glaser K (2009) Recto Anal Repair (RAR): a viable new treatment option for high-grade hemorrhoids. One year results of a prospective study. Pelviperineology 28:37–42Google Scholar
  7. 7.
    Theodoropoulos GE, Sevrisarianos N, Papaconstantinou J et al (2010) Doppler-guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III-IV haemorrhoids: a multicenter prospective study of safety and efficacy. Colorectal Dis 12:125–134PubMedCrossRefGoogle Scholar
  8. 8.
    Gupta PJ, Kalaskar S (2008) Ligation and mucopexy for prolapsing hemorrhoids—a ten year experience. Ann Surg Innov Res 2:5PubMedCrossRefGoogle Scholar
  9. 9.
    Bruch HP, Roblick UJ (2001) Pathophysiology of hemorrhoids. Chirurg 72:656–659PubMedCrossRefGoogle Scholar
  10. 10.
    Farag AE (1978) Pile suture: a new technique for the treatment of haemorrhoids. Br J Surg 65:293–295PubMedCrossRefGoogle Scholar
  11. 11.
    Block IR (1985) Obliterative suture technique for internal hemorrhoidectomy. Dis Colon Rectum 28:679–680PubMedCrossRefGoogle Scholar
  12. 12.
    Hussein AM (2001) Ligation-anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum 44:1887–1890PubMedCrossRefGoogle Scholar
  13. 13.
    Serdev N (1990) The surgical treatment of hemorrhoids. Their suturing ligation without excision. Khirurgiia 43:65–68PubMedGoogle Scholar
  14. 14.
    Awojobi OA (1983) Modified pile suture in the outpatient treatment of hemorrhoids. A preliminary report. Dis Colon Rectum 26:95–97PubMedCrossRefGoogle Scholar
  15. 15.
    Aigner F, Bodner G, Gruber H et al (2006) The vascular nature of hemorrhoids. J Gastrointest Surg 10:1044–1050PubMedCrossRefGoogle Scholar
  16. 16.
    Schuurman JP, Go PM, Bleys RL (2009) Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 11:967–971PubMedCrossRefGoogle Scholar
  17. 17.
    Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191:89–93PubMedCrossRefGoogle Scholar
  18. 18.
    Giamundo P, Cecchetti W, Esercizio L et al (2011) Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc 25:1369–1375PubMedCrossRefGoogle Scholar
  19. 19.
    Giamundo P, Salfi R, Geraci M, Tibaldi L, Murru L, Valente M (2011) The hemorrhoid laser procedure technique versus rubber band ligation: a randomized trial comparing 2 mini-invasive treatments for second- and third-degree hemorrhoids. Dis Colon Rectum 54:693–698PubMedCrossRefGoogle Scholar
  20. 20.
    Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y (2011) 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 54:226–231PubMedCrossRefGoogle Scholar
  21. 21.
    Bronstein M, Issa N, Gutman M, Neufeld D (2008) Ligation under vision of haemorrhoidal cushions for therapy of bleeding haemorrhoids. Tech Coloproctol 12:119–122PubMedCrossRefGoogle Scholar
  22. 22.
    Pakravan F, Helmes C, Baeten C (2009) Transanal open hemorrhoidopexy. Dis Colon Rectum 52:503–506PubMedCrossRefGoogle Scholar
  23. 23.
    Tagariello C (2010) Manual hemorrhoidopexy in the treatment of hemorrhoidal disease. Updates Surg 63:45–50CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • P. J. Gupta
    • 1
  • S. Kalaskar
    • 1
  • S. Taori
    • 1
  • P. S. Heda
    • 1
  1. 1.Fine Morning Hospital and Research CenterGupta Nursing HomeNagpurIndia

Personalised recommendations