Abstract
Purpose
Doppler-guided ligation of the hemorrhoidal arteries was described as an alternative to hemorrhoidectomy. The authors report their experience with this procedure.
Methods
From 2002 to 2004, 100 consecutive patients underwent hemorrhoidal artery ligation procedure for symptomatic hemorrhoids and were reviewed at one month and at three years.
Results
There were 54 females. Seventy-eight patients had Grade III hemorrhoids. Eighteen patients had previously been treated for the disease. The mean operative time was 28 minutes. On average, 8.4 ligatures were placed. Seventy-nine patients were discharged the same day. Six patients presented with early complication: isolated pain in one, pain and bleeding in three, isolated bleeding in one, and obstructed defecation in one. Late complications occurred in six patients: anal pain in one, fissure in two, and thrombosis of residual hemorrhoids in three. Twelve patients presented with a recurrence at a mean delay of 12.6 months, which was treated by repeat hemorrhoidal artery ligation (n = 1), hemorrhoidopexy (n = 7), and hemorrhoidectomy (n = 4).
Conclusions
Hemorrhoidal artery ligation procedure is safe, easy to perform, and should be considered as an alternative for the treatment of symptomatic hemorrhoids, even with a recurrence rate of 12 percent, which can be treated by the same technique or another.
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References
Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992;35:477–81.
Loder PB, Kamm MA, Nicholls RJ, Phillips RK. Haemorrhoids: pathology, pathophysiology and aetiology. Br J Surg 1994;81:946–54.
Hardy A, Chan CL, Cohen CR. The surgical management of haemorrhoids: a review. Dig Surg 2005;22:26–33.
Morinaga K, Hasuda K, Ikeda T. A 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 1995;90:610–3.
Milligan ET, Morgan CN, Jones LE, Officer R. Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet 1937;2:1119–24.
Johannsson HO, Graf W, Pahlman L. Long-term results of haemorrhoidectomy. Eur J Surg 2002;168:485–9.
Iyer VS, Shrier I, Gordon PH. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 2004;47:1364–70.
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 to 6, 1998. Bologna: Ed. Monduzzi Editore, 1998:777–84.
Khalil KH, O’Bichere A, Sellu D. Randomized clinical trial of sutured versus stapled closed haemorrhoidectomy. Br J Surg 2000;87:1352–5.
Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomized controlled trial. Lancet 2000;355:782–5.
Kairaluoma M, Nuorva K, Kellokumpu I. Day-case stapled (circular) vs. diathermy hemorrhoidectomy: a randomized, controlled trial evaluating surgical and functional outcome. Dis Colon Rectum 2003;46:93–9.
Cheetham MJ, Cohen CR, Kamm MA, Phillips RK. A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 2003;46:491–7.
Molloy RG, Kingsmore D. Life-threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet 2000;355:810.
Cheetham MJ, Mortensen NJ, Nystrom PO, Kamm MA, Phillips RK. Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet 2000;356:730–3.
Herold A, Kirsch J. Pain after stapled haemorrhoidectomy. Lancet 2000;356:2187.
How YH, Seow-Choen F, Tsang C, Eu KW. Randomized trial assessing anal sphincter injuries after stapled haemorrhoidectomy. Br J Surg 2001;88:1449–55.
Ripetti V, Caricato M, Arullani A. Rectal perforation, retropneumoperitoneum and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rectum 2002;45:268–70.
Maw A, Eu KW, Seow-Choen F. Retroperitoneal sepsis complicating stapled hemorrhoidectomy. Report of a case and review of the literature. Dis Colon Rectum 2002;45:826–8.
Oughriss M, Yver R, Faucheron JL. Complications of stapled hemorrhoidectomy: a French multicentric study. Gastroenterol Clin Biol 2005;29:429–33.
Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S. Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006;191:89–93.
Felice G, Privitera A, Ellul E, Klaumann M. Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 2005;48:2090–3.
Sohn N, Aronoff JS, Cohen FS, Weinstein MA. Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 2001;182:515–9.
Bursics A, Morvay K, Kupcsulik P, Flautner L. Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis 2004;19:176–80.
Ramirez JM, Aguilella V, Elia M, Gracia JA, Martinez M. Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Rev Esp Enferm Dig 2005;97:97–103.
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Faucheron, JL., Gangner, Y. Doppler-Guided Hemorrhoidal Artery Ligation for the Treatment of Symptomatic Hemorrhoids: Early and Three-Year Follow-up Results in 100 Consecutive Patients. Dis Colon Rectum 51, 945–949 (2008). https://doi.org/10.1007/s10350-008-9201-z
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DOI: https://doi.org/10.1007/s10350-008-9201-z