Management of Hemorrhoids with Doppler-Guided Hemorrhoidal Artery Ligation

Abstract Background An innovative therapy for symptomatic hemorrhoids has been recently proposed it relies on the reduction of hemorrhoidal vascular flow by suturing hemorrhoidal arteries, which are previously located by means of an ultrasound transducer. Objective To evaluate retrospectively the outcome of Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Patients and Methods Aretrospective study. The study conducted in Ain Shams University Hosptial (El Demerdash) under supervision of these supervisors. Study period: Six months. Results In our series, the HAL technique has achieved complete control of symptoms in 93.3% of patients after six-monthes follow-up. Conclusion Hemorrhoid ligation with mucopexy is a simple, safe and cost-effective ambulatory treatment for the patients of symptomatic hemorrhoids. It can be performed on an outpatient or day care basis on all grades of hemorrhoids to control bleeding and prolapsing hemorrhoids. Overall the results of hemorrhoid ligation and mucopexy were satisfactory with good control of patients complains.

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Clinical Outcomes in Patients with Hemorrhoids Treated by Finger Guided Hemorrhoidal Artery Ligation with Laser Hemorrhoidoplasty: A Retrospective Cohort Study

Journal of Advances in Medicine and Medical Research ◽

10.9734/jammr/2021/v33i1831064 ◽

2021 ◽

pp. 143-152

Author(s):

Kamal Gupta ◽

Niranjan Agarwal ◽

Kushal Mital

Keyword(s):

Clinical Outcomes ◽

Cost Effective ◽

Effective Alternative ◽

Invasive Technique ◽

Artery Ligation ◽

Spontaneous Bleeding ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Cost Effective Alternative ◽

The Impact

Background: Hemorrhoids are the most common anorectal disease. In Finger guided Hemorrhoidal Artery Ligation (FGHAL), the branches of Superior Hemorrhoidal Artery (SHA) are ligated after palpating the arteries with finger 2-3 cm above dentate line instead of using a doppler as in Doppler-guided Hemorrhoidal Artery Ligation (DGHAL). The procedure is followed by Laser Hemorrhoidoplasty (LHP), a minimally invasive technique. Methods: We conducted the study to retrospectively analyze the clinical outcomes of FGHAL with LHP for surgical management in a patient cohort with hemorrhoids in routine clinical practice. We retrospectively collected and analyzed the data from hospital records of patients treated with FGHAL with LHP for their hemorrhoid disease (HD) from March 2017– March 2020 to understand the impact on pain, bleeding, and resolution of symptoms. Results: The study included a total of 346 patients within 27 to 75 years of age. The presenting features were bleeding (93%), pain (89%), and prolapsed hemorrhoids (69%). Most patients had grade II hemorrhoids (60.7%). Patients reported no spontaneous bleeding after surgery; 225 patients (65%) experienced post-defecatory bleeding the day one after surgery and 98 patients (28.3%) on postoperative day 3. Patients did not report any bleeding after the 7th postoperative day. 90.2% had completely resolved symptoms 6-months after surgery. The average VAS score at 6h,12h,24h,48h and 72h after surgery were 3,2.2,1.3,0.4 and 0.1 respectively. Conclusion: FGHAL is a cost-effective alternative to DGHAL. FGHAL, followed by the LHP technique, provides a very low pain and discomfort with minimal need for analgesics and wound care, electing it among the procedures suitable for HD. The method is a cost-effective alternative to DGHAL.

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Doppler-Guided Hemorrhoid Artery Ligation with Recto-Anal-Repair Modification: Functional Evaluation and Safety Assessment of a New Minimally Invasive Method of Treatment of Advanced Hemorrhoidal Disease

The Scientific World JOURNAL ◽

10.1100/2012/324040 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 12

Author(s):

Piotr Walega ◽

Michal Romaniszyn ◽

Jakub Kenig ◽

Roman Herman ◽

Wojciech Nowak

Keyword(s):

Safety Assessment ◽

Mucosal Prolapse ◽

Hemorrhoidal Disease ◽

Functional Evaluation ◽

Artery Ligation ◽

Major Complications ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Invasive Method ◽

Grade Iii

Purpose: We present 12-month followup results of functional evaluation and safety assessment of a modification of hemorrhoidal artery ligation (DGHAL) called Recto-Anal-Repair (RAR) in treatment of advanced hemorrhoidal disease (HD).Methods: Patients with grade III and IV HD underwent the RAR procedure (DGHAL combined with restoration of prolapsed hemorrhoids to their anatomical position with longitudinal sutures). Each patient had rectal examination, anorectal manometry, and QoL questionnaire performed before 3 months, and 12 months after RAR procedure.Results: 20 patients completed 12-month followup. There were no major complications. 3 months after RAR, 5 cases of residual mucosal prolapse were detected (25%), while only 3 patients (15%) reported persistence of symptoms. 12 months after RAR, another 3 HD recurrences were detected, to a total of 8 patients (40%) with HD recurrence. Anal pressures after RAR were significantly lower than before (P<0.05), and the effect was persistent 12 months after RAR. One patient (5%) reported occasional soiling 3 months after RAR.Conclusions: RAR seems to be a safe method of treatment of advanced HD with no major complications. The procedure has a significant influence on anal pressures, with no evidence of risk of fecal incontinence after the operation.

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Decreased blood flow to the posterior anal canal shown during Doppler-guided hemorrhoidal artery ligation explains anodermal ischemia in anal fissure

Techniques in Coloproctology ◽

10.1007/s10151-017-1636-6 ◽

2017 ◽

Vol 21 (5) ◽

pp. 411-412 ◽

Cited By ~ 2

Author(s):

B. Trilling ◽

H. Pflieger ◽

J. L. Faucheron

Keyword(s):

Blood Flow ◽

Anal Canal ◽

Anal Fissure ◽

Artery Ligation ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery

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Doppler-guided hemorrhoidal artery ligation with suture mucopexy compared with LigaSure™-assisted pile excision for the treatment of grade III hemorrhoids: a prospective randomized controlled trial

Minerva Surgery ◽

10.23736/s2724-5691.20.08429-1 ◽

2021 ◽

Vol 76 (3) ◽

Author(s):

Xiao-Lun LEE ◽

Kuo-Fang HSU ◽

Yau-Dung JIN ◽

Ping-Wun HUANG ◽

Li-Chun YEH ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Controlled Trial ◽

Artery Ligation ◽

Randomized Controlled ◽

Hemorrhoidal Artery Ligation ◽

Prospective Randomized Controlled Trial ◽

Hemorrhoidal Artery ◽

Grade Iii

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Hemorrhoidal artery ligation with Doppler guidance vs digital guidance for grade II-III hemorrhoidal disease treatment

Medicine ◽

10.1097/md.0000000000019424 ◽

2020 ◽

Vol 99 (15) ◽

pp. e19424

Author(s):

Daniil Markaryan ◽

Inna Tulina ◽

Tatiana Garmanova ◽

Mikhail Bredikhin ◽

Aftandil Alikperzade ◽

...

Keyword(s):

Hemorrhoidal Disease ◽

Disease Treatment ◽

Artery Ligation ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery ◽

Grade Ii

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A Randomized Clinical Study to Compare the Outcome of Hemorrhoidal Artery Ligation (HAL) Procedure with and without Doppler Guidance in Grades I–III Hemorrhoidal Disease

Indian Journal of Surgery ◽

10.1007/s12262-020-02606-z ◽

2020 ◽

Author(s):

Arshad Ahmad ◽

Mohd Kalimuddin ◽

Abhinav Arun Sonkar ◽

Suresh Kumar ◽

Pankaj Kumar ◽

...

Keyword(s):

Clinical Study ◽

Hemorrhoidal Disease ◽

Artery Ligation ◽

Randomized Clinical Study ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery

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Doppler-Guided Hemorrhoidal Artery Ligation: Experience with 2 Years Follow-up

The American Surgeon ◽

10.1177/000313481207800345 ◽

2012 ◽

Vol 78 (3) ◽

pp. 344-348 ◽

Cited By ~ 1

Author(s):

İbrahim Yilmaz ◽

İlker Sücüllü ◽

Dursun Özgür Karakaş ◽

Yavuz Özdemİr ◽

Ergün Yücel ◽

...

Keyword(s):

Postoperative Pain ◽

Average Length ◽

Length Of Hospital Stay ◽

Artery Ligation ◽

Superior Rectal Artery ◽

Quick Recovery ◽

Doppler Probe ◽

Hemorrhoidal Artery Ligation ◽

Hemorrhoidal Artery

Doppler-guided hemorrhoidal artery ligation (DGHAL) is a nonexcisional surgical technique for the treatment of hemorrhoidal disease, consisting of the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of hemorrhoidal plexus resulting in fibrosis. The aim of the study was to assess the efficacy and safety of DGHAL, define its indications, and identify its possible advantages and limitations for the treatment of second- and third-degree hemorrhoids. The procedure was performed using a specially designed proctoscope. The Doppler probe was used to locate all the terminal branches of hemorrhoidal arteries, which were then sutured. Patients were followed up for 2 years. From November 2006 to May 2009, 50 patients (29 female, mean age 38.2 years) underwent this procedure. The procedure was performed under local anesthesia. An average of five ligatures was placed. Average length of hospital stay was 2 hours and return to work was 2.5 days. The mean postoperative pain score was 1.72. There were no intra- or immediate postoperative major complications. In 44 patients (88%), surgery resolved the symptoms completely in a 2-year follow-up period. DGHAL is a safe and effective procedure. DGHAL can be the choice for second- and third-degree hemorrhoids with minimal postoperative pain and quick recovery.

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