Treatment of Grade 2 and 3 Hemorrhoids with Doppler-Guided Hemorrhoidal Artery Ligation

Abstract

Aim: We evaluated the results of the Doppler-guided hemorrhoidal arterial ligation (DG-HAL) method in the management of symptomatic grade 2 and 3 hemorrhoids. Patients and Methods: Between June 2005 and March 2006, 110 consecutive patients with symptomatic grade 2 and 3 hemorrhoids according to the DG-HAL method were treated. All procedures were performed in daycare under spinal anesthesia. The primary objective was the reduction in hemorrhoidal gradation as determined by proctoscopy; the secondary was patient satisfaction. This was measured by interviewing patients over the telephone. Results: The average age was 47.6 years. 42 patients had grade 2 hemorrhoids, 68 grade 3. An average of 7.3 ligations were placed. Proctoscopy showed that, after 6 weeks, 97 (88%) patients had a significant improvement in their hemorrhoidal gradation. After an average follow-up of 37 weeks, 93 of the 110 (84.5%) patients were satisfied with the postoperative result. Mortality was 0% and morbidity 3%. Conclusion: DG-HAL is a safe and effective treatment in the management of symptomatic grade 2 and 3 hemorrhoids.

Comparison of Doppler Guided Hemorrhoid Artery Ligation and Milligan Morgan Hemorrhoidectomy in Management of Hemorrhoidal Disease

“…In a study by Ramirez et al, they also evaluated symptom improvements in patients with grade IV hemorrhoids, who underwent the DGHAL technique and they concluded that most failures occurred in this group (up to 70%). This finding is inconsistent with our study, (8,16) because we observed much better outcomes (no failure), but other elements of Ramirez's study and other studies confirmed our results (4,8,10,17,18). Some studies added some modalities such as recto anal repair adjunct to DGHAL with similar results to DGHAL alone (6,16,19 (20).…”

“…(1,3,4). This technique has been introduced by Morinaga in 1995 23 or Jespersen in 1992, 24 who used a Doppler proctoscope with injected sclerosing agent instead of ligation in the classic Morinaga procedure.…”

Emborrhoid: A New Concept for the Treatment of Hemorrhoids with Arterial Embolization: The First 14 Cases

“…This method, comparable to the elastic band ligations performed blind for several decades, is effective in internal hemorrhoidal disease where there is no prolapse. Several descriptive studies [20][21][22][23][24][25] have reported a shortterm efficacy rate of 90 %, and long-term efficacy of 70-92 %. Post-operative pain was present in 1-6 % of cases.…”

Results of 244 Consecutive Patients with Hemorrhoids Treated with Doppler-Guided Hemorrhoidal Artery Ligation

“…With early success rates of up to 97% [12] and reportedly low complication rates, it seems to be an ideal treatment. Initially, we reported equally good results with a success rate of 85% after an average follow-up of 9 months [10]. Nevertheless, very little is known about its long-term effects and, until now, just 4 studies have shown their results after long-term (>1 year) follow-up [2,5,8,13].…”

“…Nevertheless, the rates of effectiveness and patient satisfaction after long-term follow-up are still unknown and, currently, no large, prospective, randomized, controlled trial has been published. We previously published our first experiences and results with DG-HAL [10]. In this article, we describe the long-term follow-up results of this procedure.…”