Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Jun 8;4(2):e296.
doi: 10.1097/AS9.0000000000000296. eCollection 2023 Jun.

Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study

Luca Domenico Bonomo  1 , Ezio Falletto  2 , Salvatore Cuccomarino  3 , Antonella Nicotera  1 , Alberto Jannaci  3
Affiliations

Hemorrhoidal Artery Ligation for the Treatment of Grade II-III Hemorrhoids: Is it Worth the Use of Doppler Guide in Long-Term Follow-Up?: A Single-Center Cohort Study

Luca Domenico Bonomo et al. Ann Surg Open. .

Abstract

Background: Hemorrhoidal artery ligation (HAL) may reduce postoperative pain and complications and shorten patients' recovery when compared to standard hemorrhoidectomy. It is unclear if the Doppler guide (DG) is useful in reducing recurrence risk.

Objective: To compare two groups of patients (treated with DG-HAL or HAL) in terms of recurrence risk and patients' satisfaction grade.

Methods: Between January 1, 2014 and January 31, 2021, 122 patients affected by grade II-III hemorrhoidal prolapse underwent DG-HAL or HAL at Chivasso Hospital, Italy. Mucopexy was routinely performed. After discharge, patients were subjected to 1-week, 1-, 3-, 6-, and 12-month clinical assessment. Thereafter, they were interviewed by telephone annually.

Results: Seventy-six (62.3%) DG-HAL and 46 (37.7%) HAL procedures were performed. Median surgical time was 30 (15-45) minutes for DG-HAL versus 25 (15-40) minutes for HAL (P = 0.005). No intraoperative complications occurred. Postoperative bleeding needing surgery occurred in 2 (1.6%) patients in the DG-HAL group. During a median follow-up of 46 months (6-86), we registered 18 (23.7%) recurrences in the DG-HAL group and 13 (28.3%) in the HAL one (P = 0.574). No cases of incontinence or anal stenosis occurred. No significant difference was observed between the two groups in terms of patients' satisfaction. At multivariate analysis, age ≥ 65 years resulted a protective factor for recurrence (odds ratio 0.31; 95% confidence interval 0.09-0.98; P = 0.047).

Conclusions: In our study, the use of DG did not reduce recurrence risk. Operative time was significantly increased in the DG-HAL group.

Keywords: anorectal surgery; cohort study; hemorrhoidal artery ligation; hemorrhoidal disease; mucopexy.

PubMed Disclaimer

Figures

FIGURE 1.
FIGURE 1.
Preoperative condition.
FIGURE 2.
FIGURE 2.
The self-anchoring device (HPSP) is placed in the anal canal. The rotating part is moved to realize arterial ligation and mucopexy at 1–3–5–7–9–11 o’clock.
FIGURE 3.
FIGURE 3.
Once the site is identified, arterial ligation and running suture are performed (HAL).
FIGURE 4.
FIGURE 4.
Results after surgery (HAL).
See this image and copyright information in PMC

References

    1. Riss S, Weiser FA, Schwameis K, et al. . The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27:215–220. - PubMed
    1. Hussain JN. Hemorrhoids. Prim Care. 1999;26:35–51. - PubMed
    1. Sardinha TC, Corman M. Hemorrhoids. Surg Clin North Am. 2002;82:1153–1167. - PubMed
    1. Milligan ET, Morgan CN, Jones LE. Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet. 1937;2:1119.
    1. Ferguson JA, Mazier WP, Ganchrow MI, et al. . The closed technique of hemorrhoidectomy. Surgery. 1971;70:480–484. - PubMed