Main Disadvantages of Dearterialization of Hemorrhoids and Mucopexy
Ligation techniques, such as Doppler-guided dearterialization of hemorrhoids (DH), were introduced to reduce the arterial inflow to the hemorrhoidal zone and thus preserve it as part of the continence system. Apart from inappropriate application of this surgical alternative for higher grade hemorrhoids, high recurrence rates of up to 30% after DH are due to technical failure of the ligation technique itself. Doppler-guided ligations can be set too high above the hemorrhoidal zone, missing the targeted submucosal branches of the superior rectal artery. However, prolapsing hemorrhoids have been proposed to be insufficiently treated by solely interrupting the arterial inflow without repositioning the hemorrhoidal zone by mucopexy in DH. To overcome the shortcomings of the DG-HAL procedure, suture ligation modifications have been made, which address the pexy of the hemorrhoidal prolapse by fixing it above the dentate line.
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