Early Experience of Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal Repair (DG-HAL & RAR) for the Treatment of Symptomatic Hemorrhoids

Abstract

Purpose: This study is to introduce our preliminary experience of the Doppler-guided hemorrhoidal artery ligation and Rectoanal repair (DG-HAL & RAR) as a new treatment for symptomatic or prolapsed hemorrhoids. Methods: A Doppler probe incorporated proctoscope was inserted under the lithotomy position and the location of the hemorrhoidal artery was identified. The identified artery was ligated as a 'figure of eight' method with an absorbable suture into the submucosa. Then the prolapsed hemorrhoidal pile was lifted at the rectal mucosa by continuous suture to 5 mm above the dentate line and tied. The procedure was repeated at the 1, 3, 5, 7, 9, and 11 o'clock positions. We evaluated post-operative hospital stay, degree of pain, time to return to work, and recurrence. Results: The patient's mean age was 50.2±15 years old and the mean follow-up time was 415±75 days. The constitution of the type of internal hemorrhoids was as follows: Grade II: 13, Grade III: 16, and Grade IV: 5. The mean operation time was 35 minutes and post-operative hospital stay was 1.4 days. The mean time it took to return to work was 1.8 days. There were no severe pains requiring injection of analgesics or other severe complications. So far, 2 patients have had recurrence of symptoms.

A prospective study on suture ligation of internal hemorrhoids without Doppler guidance for the treatment of symptomatic hemorrhoid disease

“…[1][2][3][4][5][6][7] Dearterialization procedures like hemorrhoid artery ligation have a recurrence rate of 5-18% in various studies. [8][9][10][11][12][13][14][15][16][17][18][19] We didn't have long term results in our study but short term results in our study showed that a single treatment can achieve satisfactory results. If the symptoms of bleeding and prolapse due to hemorrhoids are not relieved, further hemorrhoid ligation or other conservative treatment may be tried.…”

“…It has also been shown to be effective in over 90% of cases, with recurrence of 5-18% in different studies. [8][9][10][11][12][13][14][15][16][17][18][19] In a double blind randomized control trial comparing Doppler guided hemorrhoidal artery ligation and mucopexy with simple ligation of hemorrhoids and mucopexy no advantage was found for the Doppler group.…”

“…Dearterialization of hemorrhoids, either with suture ligation (DGHAL/THD) or laser along with mucopexy for prolapsing hemorrhoids has been studied and found to be safe and effective minimally invasive outpatient treatment for symptomatic hemorrhoids. [8][9][10][11][12][13][14][15][16][17][18][19][20] However the added value of Doppler guidance has recently been challenged in some studies. 11,17,18 Suture ligation of hemorrhoid pedicle without Doppler guidance has been reported by many authors in different studies but it effectiveness and advantages in treatment of hemorrhoids needs to be validated by evidence base.…”

Evaluation of Doppler-Guided Hemorrhoidal Artery Ligation (DGHAL) as a Novel Technique in Management of Hemorrhoids

“…Only 14 patients (14.4%) experienced a recurrence of their preoperative symptoms at the one-year follow-up, and no significant consequences were found. 15 Additionally, Sherif (2016) 18 The clinical and functional outcomes of Dopplerguided (DG) haemorrhoidal artery ligation (HAL) versus traditional haemorrhoidectomy for the treatment of grade III & IV haemorrhoids were studied by Khalil et al in 2019. They claimed that there are no serious risks while utilising DG-HAL, and that any issues are equivalent to those linked to other treatments.…”