Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids.

OBJECTIVE: The aim of this study is to clinically test the efficacy of a new approach for patients having symptomatic grade III and IV hemorrhoids.

MATERIAL AND METHOD: 32 patients (17 females) complaining of grade III or IV hemorrhoids were included in the study. A specially designed proctoscope coupled with a Doppler transducer on its tip was used to identify the hemorrhoidal arteries, which were afterwards suture ligated. Operating time as well as per- and post-operative complications were analyzed. Follow-up was planned following discharge after 1 week, 1 month, 6 months and 1 year.

RESULTS: Mean operation time was 27 (range 18-43) minutes, and 5 (range 4-7) arteries were located on average. No patient had severe or moderate postoperative pain, with anal discomfort being the main complaint. Rectal bleeding and tenesmus were the commonest post-operative complications. After one year of follow-up, 19 patients were free of symptoms and 6 of them had significant symptom relief. According to grade, the technique failed in just 3 grade III patients, but in as many as 4 grade IV hemorrhoid cases.

CONCLUSIONS: Doppler-guided hemorrhoid artery ligation is an easy-to-perform technique that is well accepted by patients and has good results for grade III hemorrhoids.