Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrhoidal artery ligation: functional results after 1-year follow-up

Piotr Wałega, Mathias Scheyer, Jakub Kenig, Roman M Herman, Steffen Arnold, Marcin Nowak, Tomasz Cegielny
Surgical Endoscopy 2008, 22 (11): 2379-83

INTRODUCTION: Doppler-guided hemorrhoidal artery ligation (DGHAL), as a method of treating hemorrhoidal disease, is currently used in many centers across Europe, Asia, and Australia. The aim of our study was to evaluate the clinical effectiveness and functional results of DGHAL as estimated by means of anorectal manometry.

MATERIALS AND METHODS: Between 2000 and 2006 the DGHAL procedure was performed on 507 patients with II-IV degree hemorrhoids in two centers (Poland and Austria). Three hundred eight patients were included in the initial phase of the study, designed to estimate the method's effectiveness. During the second phase (199 patients) selected functional results were also assessed. Patients were classified as having grade II (144), III (319), and IV (44) hemorrhoids.

RESULTS: There were no intra- and immediate postoperative complications. Good results were reported by 351 patients (69.2%), and were acceptable in a further 75 cases (4.8%). When the patients were grouped according to the stage of hemorrhoidal disease, 133 out of 144 patients (92.4%) with grade II and 272 out of 324 (84%) with grade III had very good or good results. Only 18 out of 44 patients (41%) with grade IV were satisfied with the operation. Fifty-nine patients after anorectal folds, fissure or anal canal polyp excision required analgesics for 1-2 days. Apart from lower contraction amplitude and contraction speed after 1 month there were no differences in anorectal functional tests.

CONCLUSION: Based on our results we may conclude that DGHAL is a safe and effective method and may offer an important alternative to operative hemorrhoidectomy with no risk of postoperative stool incontinence, minimal postoperative pain, and early return of patients to their normal activities. Nevertheless, this is a fairly new procedure with a short-term follow-up. Until 5-year observations of large, multicenter, randomized trials are published we cannot recommend this method as a gold-standard procedure, although it still can offer significant benefits to patients.

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