Doppler‐guided haemorrhoidal artery ligation: long‐term outcome and patient satisfaction

Abstract

Objective Conventional Milligan-Morgan haemorrhoidectomy is associated with significant pain and potentially hazardous complications. Doppler-Guided Haemorrhoidal Artery Ligation (DGHAL) may offer a lower risk, pain-free alternative. We present our early and longterm outcome experience with DGHAL, combined with patient views and satisfaction with the procedure.Method One hundred and thirteen DGHALs were performed over a 13 month period by two surgeons in a single centre. Patients graded the severity of postoperative pain on visual-analogue scales. Clinical follow-up was at 6 weeks (n = 103), with long-term follow-up (n = 90) by postal questionnaire at median of 30 months.Results Seven out of one hundred and three (6%) patients reported postoperative discomfort requiring analgesia. Ninety-three out of one hundred and three (90%) patients reported complete relief or significant improvement in their symptoms at 6 weeks, dropping to 77 ⁄ 90 (86%) at 30 months. Anal fissures developed in 2 ⁄ 103 (2%) patients, both treated with Diltiazem ointment. Further surgery was required in 8 ⁄ 90 (9%) patients. Eighty-two out of ninety (91%) patients said they would undergo DGHAL again.Conclusion DGHAL is a relatively painless, safe, and effective procedure for symptomatic stage I-III haemorrhoids, for which we have demonstrated long-term durability and acceptability. Its role lies between office based procedures and more invasive operative interventions.

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

“…5 However, it should be noted that the recurrence rate among the constituent studies varied considerably and ranged up to 60%. 64 Similarly, reported recurrence rates for RBL also vary widely in the literature, ranging from 11% to > 50%. [6][7][8][9][10][11] This range can be attributed to many factors, but the most pertinent is probably the difficulty in defining exactly what constitutes recurrence.…”

“…[6][7][8][9][10][11] This range can be attributed to many factors, but the most pertinent is probably the difficulty in defining exactly what constitutes recurrence. Some studies rely on clinical examination and patient-reported symptoms, 22,25,27,51,64 whereas others rely solely on symptomatology. 24,32 When considering symptoms only, some investigators consider a patient to be recurrence free when they have no perianal symptoms at all, whereas others consider this simply an improvement.…”

“…24,32 When considering symptoms only, some investigators consider a patient to be recurrence free when they have no perianal symptoms at all, whereas others consider this simply an improvement. A classic example of variation dependent on definition is provided by one study 64 reporting a very high recurrence rate of 60% at 30 months after a HAL procedure. However, the investigators report that, at the same time point, 86% of patients described a significant improvement in symptoms.…”

Innovations and developments in surgical coloproctology

“…27 DGHAL uses a Doppler probe to locate the terminal branches of the haemorrhoidal artery, then a suture is used to ligate these at multiple locations. Symptom resolution has been reported in around 85% of patients, 28 and the procedure seems to be less painful than traditional haemorrhoidectomy.…”

The minimally invasive surgery in patients with chronic haemorroidal disease

“…Наиболее часто применяются следующие мало-инвазивные методы лечения геморроя [1,7,18]: скле-розирование геморроидальных узлов; лигирование внутренних геморроидальных узлов латексными кольцами; инфракрасная коагуляция и электрокоа-гуляция; ультразвуковая кавитация со склерозирова-нием; дезартеризация внутренних геморроидальных узлов под контролем доплерометрии с лифтингом и мукопексией слизистой.…”