Aim: This study was designed to determine the effect of treating hemorrhoids with the Doppler-guided hemorrhoidal artery ligation (DG-HAL) procedure. Methods: From June 2005 to March 2008, 244 consecutive hemorrhoidal patients underwent hemorroidal artery ligation performed with the DG-HAL system from AMI®. All patients were evaluated postoperatively with a proctologic examination and interview. Further follow-up was performed by telephone with a standardized questionnaire. When indicated, patients revisited the clinic for further examination and treatment. Results: 244 patients were treated with DG-HAL. The mean follow-up time was 18.4 months (range 1.4–37.2). Sixty-seven percent of the patients had an improvement of symptoms after one treatment. Fifty-three patients (22%) underwent a second procedure because of persisting symptoms. Thirteen patients (25%) underwent a second DG-HAL and 40 (75%) underwent rubber band ligation. In total, 69% of the patients had a good response using the DG-HAL technique. Multivariate logistic regression analysis revealed prolapse to be an independent risk factor for persistent symptoms (OR = 2.38, 95% CI 1.10–5.15). Patients with grades 3 and 4 hemorrhoids had a higher risk of developing recurrent disease (OR = 4.94, 95% CI 0.67–36.42). Conclusion: DG-HAL seems to be an effective procedure for treating low-grade hemorrhoids. A resection procedure should be the treatment for patients with recurrent disease.

Keywords:
Hemorrhoids, Rubber band ligation, Doppler-guided hemorrhoidal artery ligation
1.
Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG: Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 1992;35:477–481.
2.
Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S: Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006;191:89–93.
3.
Janssen LW: Consensus hemorroïden (in Dutch). Ned Tijdschr Geneeskd 1994;138:2106–2109.
4.
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;90:610–613.
5.
Faucheron JL, Ganger 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 2008;51:945–949.
6.
Greenberg R, Karin E, Avital S, Skornick Y, Werbin N: First 100 cases with Doppler-guided hemorrhoidal artery ligation. Dis Colon Rectum 2006;49:485–489.
7.
Bronstein M, Issa N, Gutman M, Neufeld D: Ligation under vision of haemorrhoidal cushions for therapy of bleeding haemorrhoids. Tech Coloproctol 2008;12:119–122.
8.
Dal Monte PP, Tagariello C, Giordano P, Cudazzo E, Shafi A, Sarago M, Franzini M: Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 2007;11:333–338.
9.
Felice G, Privitera A, Ellul E, Klaumann M: Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 2005;48:2090–2093.
10.
Wallis de Vries BM, van der Beek ESJ, de Wijkerslooth LRH, van der Zwet WC, van der Hoeven JAB, Eeftinck Schattenkerk M, Eddes EH: Treatment of grade 2 and 3 hemorrhoids with Doppler-guided hemorrhoidal artery ligation. Dig Surg 2007;24:436–440.
11.
Banov L Jr, Knoepp LF Jr, Erdman LH, Alia RT: Management of hemorrhoidal disease. J S C Med Assoc 1985;81:398–401.
12.
Sohn N, Aronoff JS, Cohen FS, Weinstein MA: Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 2001;182:515–519.
13.
Wilkerson PM, Strbac M, Reece-Smith H, Middleton SB: Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction. Colorectal Dis 2009;11:394–400.
14.
Tagariello C, Dal Monte PP, Sarago M: Doppler-guided transanal haemorrhoidal dearterialisation (in Italian). Chir Ital 2004;56:693–697.
15.
Theodoropoulos GE, Sevrisarianos N, Papaconstatinou J, et al: Doppler-guided haemorrhoidal artery ligation (DGHAL), rectoanal repair (RAR), sutured haemorrhoidopexy (SHP) and minimal mucocutaneous excision (MMCE) for grade III-IV haemorrhoids: a multicenter prospective study of safety and efficacy. Colorectal Dis 2008, E-pub ahead of print.
16.
Forlini A, Manzelli A, Quaresima S, Forlini M: Long-term result after rubber band ligation for haemorrhoids. Int J Colorectal Dis 2009;24:1007–1010.
17.
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;19:176–180.
© 2010 S. Karger AG, Basel
2010
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.