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Doppler-Guided Hemorrhoidal Artery Ligation: The Experience of a Single Institution

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Purpose

This study aims to review the short-term recurrence and complications of Doppler-guided hemorrhoidal artery ligation (DG-HAL) with mucopexy.

Methods

Approval was obtained for a retrospective chart review of patients who underwent DG-HAL from January 2007 to June 2009. A treatment failure was recorded if internal hemorrhoids were noted at follow up or symptoms persisted. All recurrences were assessed for predictive factors.

Results

The procedures were performed by four surgeons. Ninety-six patients were included. The average age was 63.5 years (21–81 years). The mean follow up was 15 months (3–35 months). Of the patients, 93 (96.8%) reported bleeding pre-operatively. Mucopexy accompanied DG-HAL in 87 (90.6%). Postoperative complications occurred in nine (9%) patients. Residual hemorrhoids were evident in 20 (21%) patients, 13 of whom required further management for symptomatic disease, five with DG-HAL. Fifty percent (10/20) and 70% (9/13) of the recurrences necessitating further treatment transpired during the first 20 procedures of each surgeon. All 13 symptomatic recurrences demonstrated large, circumferential internal hemorrhoids.

Conclusions

DG-HAL is a simple procedure with a low complication rate. Recurrences are more frequent during the learning curve. Patients with large, circumferential internal hemorrhoids should be counseled about a possible higher rate of recurrence. DG-HAL can be effectively repeated for recurrences.

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Authors and Affiliations

  1. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Ursula Maria Szmulowicz, Brooke Gurland, Thomas Garofalo & Massarat Zutshi

  2. Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 16761 SouthPark Center/ST-20, Strongsville, OH, 44136, USA

    Ursula Maria Szmulowicz

Authors
  1. Ursula Maria Szmulowicz
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  2. Brooke Gurland
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  3. Thomas Garofalo
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  4. Massarat Zutshi
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Corresponding author

Correspondence to Ursula Maria Szmulowicz.

Additional information

This study was funded by the Cleveland Clinic Foundation, Digestive Disease Institute, Department of Colorectal Surgery, 9500 Euclid Avenue, Cleveland, Ohio 44195.

This study was a poster presentation at the annual meeting of the American Society of Colon and Rectal Surgeons, Minneapolis, Minnesota, May 15–19, 2010 and was also a podium presentation at the annual meeting of the Association of Coloproctology of Great Britain and Ireland, June 28–30, 2010.

Assistance for travel to the meeting of the Association of Coloproctology of Britain and Ireland was provided by AMI for one author.

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Szmulowicz, U.M., Gurland, B., Garofalo, T. et al. Doppler-Guided Hemorrhoidal Artery Ligation: The Experience of a Single Institution. J Gastrointest Surg 15, 803–808 (2011). https://doi.org/10.1007/s11605-011-1460-7

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  • DOI: https://doi.org/10.1007/s11605-011-1460-7

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