PURPOSE
Postoperative pain is the main adverse effect of formal hemorrhoidectomy. A new technique based on Doppler-guided ligation of the terminal branches of the superior hemorrhoidal artery was introduced in 1995 as an alternative to hemorrhoidectomy. The authors report a preliminary experience with this procedure.
METHODS
The Doppler-guided hemorrhoidal artery ligation technique uses a special proctoscope bearing a Doppler transducer that allows identification and suture ligation of the hemorrhoidal arteries. Sixty-eight consecutive patients (mean age, 48 years; range, 21–74 years) with Grade 3 hemorrhoids were treated.
RESULTS
Intraoperative discomfort was measured by a visual analog scale (1–10) and resulted in a mean score of 2.3 (range, 1.3–2.8). Only 38 percent of patients required postoperative analgesia. Patients were examined at 1 week, 1 month, and 3 months and every 6 months thereafter. The mean follow-up was 11 (range, 3–18) months. Bleeding resolved in 91 percent of patients, pain in 73 percent, and prolapse in 94 percent. Complications were recorded in five patients and included persistent pain for more than two days in two patients (3 percent), swelling and thrombosis of one of the hemorrhoids in two patients (3 percent), and a secondary hemorrhage in one patient (1.5 percent).
CONCLUSION
Doppler-guided ligation of the hemorrhoidal artery is a safe and effective alternative to hemorrhoidectomy and is associated with minimal discomfort and low risk of complications.
Similar content being viewed by others
REFERENCES
R Bleday JP Pena DA Rothenberger SM Goldberg JG Buls (1992) ArticleTitleSymptomatic hemorrhoids: current incidence and complications of operative therapy Dis Colon Rectum 35 477–81 Occurrence Handle1568400 Occurrence Handle10.1007/BF02049406 Occurrence Handle1:STN:280:By2B3szns1I%3D
K Morinaga K Hasuda T Ikeda (1995) ArticleTitleA 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 90 610–3 Occurrence Handle7717320 Occurrence Handle1:STN:280:ByqB3szjsFU%3D
ET Milligan CN Morgan LE Jones R Officer (1937) ArticleTitleSurgical anatomy of the anal canal and the operative treatment of haemorrhoids Lancet 2 1119–24
D Palimento M Picchio U Attanasio A Lombardi C Bambini A Renda (2003) ArticleTitleStapled and open hemorrhoidectomy: randomized controlled trial of early results World J Surg 27 203–7 Occurrence Handle12616437
HO Johannsson W Graf L Pahlman (2002) ArticleTitleLong-term results of haemorrhoidectomy Eur J Surg 168 485–9 Occurrence Handle12549690
R Shalaby A Desoky (2001) ArticleTitleRandomised clinical trial of stapled versus Milligan-Morgan haemorrhoidectomy Br J Surg 88 1049–53 Occurrence Handle11488788 Occurrence Handle10.1046/j.0007-1323.2001.01830.x Occurrence Handle1:STN:280:DC%2BD3MvktlWhsQ%3D%3D
MJ Cheetham RK Phillips (2001) ArticleTitleEvidence-based practice in haemorroidectomy Colorectal Dis 3 126–34 Occurrence Handle12791006 Occurrence Handle10.1046/j.1463-1318.2001.00189.x Occurrence Handle1:STN:280:DC%2BD3s3msFSisA%3D%3D
VS Iyer I Shrier PH Gordon (2004) ArticleTitleLong-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids Dis Colon Rectum 47 1364–70 Occurrence Handle15484351 Occurrence Handle10.1007/s10350-004-0591-2 Occurrence Handle1:STN:280:DC%2BD2crht1WlsQ%3D%3D
VA Komborozos GJ Skrekas CA Pissiotis (2000) ArticleTitleRubber band ligation of symptomatic internal hemorrhoids: results of 500 cases Dig Surg 17 71–6 Occurrence Handle10720835 Occurrence Handle10.1159/000018803 Occurrence Handle1:STN:280:DC%2BD3c7ovVSrtA%3D%3D
PB Loder MA Kamm RJ Nicholls RK Phillips (1994) ArticleTitleHaemorrhoids: pathology, pathophysiology and aetiology Br J Surg 81 946–54 Occurrence Handle7922085 Occurrence Handle1:STN:280:ByqD3cnjsl0%3D
O Thulesius JE Gjores (1973) ArticleTitleArterio-venous anastomoses in the anal region with reference to the pathogenesis and treatment of haemorrhoids Acta Chir Scand 139 476–8 Occurrence Handle4748712 Occurrence Handle1:STN:280:CSuD383gt1A%3D
Thomson WH. The anatomy and nature of piles. In: Kaufmann HD, ed. The haemorrhoidal syndrome. Tunbridge Wells: Abacus Press, 1981:15–33
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
Longo A. Treatment of haemorrhoidal disease by reduction of mucosa and haemorrhoidal prolapse with a circular stapling device: a new procedure. Proceedings of 6th World Congress of Endoscopic Surgery, Rome, June 3–6, 1998. Bologna: Ed. Monduzzi Editore, 1998:777–84
MJ Cheetham CR Cohen MA Kamm RK Phillips (2003) ArticleTitleA randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up Dis Colon Rectum 46 491–7 Occurrence Handle12682543 Occurrence Handle10.1007/s10350-004-6588-z Occurrence Handle1:STN:280:DC%2BD3s7msVeisg%3D%3D
KH Khalil A O'Bichere D Sellu (2000) ArticleTitleRandomized clinical trial of sutured versus stapled closed haemorrhoidectomy Br J Surg 87 1352–5 Occurrence Handle11044160 Occurrence Handle10.1046/j.1365-2168.2000.01624.x Occurrence Handle1:STN:280:DC%2BD3crgtVGlug%3D%3D
M Kairaluoma K Nuorva I Kellokumpu (2003) ArticleTitleDay-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome Dis Colon Rectum 46 93–9 Occurrence Handle12544528
MJ Cheetham NJ Mortensen PO Nystrom MA Kamm RK Phillips (2000) ArticleTitlePersistent pain and faecal urgency after stapled haemorrhoidectomy Lancet 356 730–3 Occurrence Handle11085693 Occurrence Handle1:STN:280:DC%2BD3M%2FjvVKquw%3D%3D
V Ripetti M Caricato A Arullani (2002) ArticleTitleRectal perforation, retropneumoperitoneum and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations Dis Colon Rectum 45 268–70 Occurrence Handle11852343 Occurrence Handle10.1007/s10350-004-6159-3
Molloy RG, Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet 2000;355:810
N Sohn JS Aronoff FS Cohen MA Weinstein (2001) ArticleTitleTransanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy Am J Surg 182 515–9 Occurrence Handle11754861 Occurrence Handle10.1016/S0002-9610(01)00759-0 Occurrence Handle1:STN:280:DC%2BD38%2FksVyhsw%3D%3D
JM Ramirez V Aguilella M Elia JA Gracia M Martinez (2005) ArticleTitleDoppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids Rev Esp Enferm Dig 97 97–103 Occurrence Handle15801885 Occurrence Handle1:STN:280:DC%2BD2M3ht1eqtQ%3D%3D
ACKNOWLEDGMENT
The authors thank Mr. Kurt Camilleri for assistance.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Felice, G., Privitera, A., Ellul, E. et al. Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy. Dis Colon Rectum 48, 2090–2093 (2005). https://doi.org/10.1007/s10350-005-0166-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-005-0166-x