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Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids

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Abstract

Purpose

Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope was redesigned to incorporate a window through which a recto anal repair (RAR) could be performed to improve the outcome in patients with significant prolapse symptoms. The aim of this study was to observe the outcome of a series of consecutive DGHAL–RAR procedures.

Method

Seventy-seven consecutive patients (49 male) underwent DGHAL–RAR for symptomatic haemorrhoids and were reviewed for a minimum of 6 months post-surgery.

Results

Fifty-seven (74%) of patients presented with both prolapse and bleeding symptoms. The median number of DGHALs performed was six, and the median number of RARs was two. Most (96%) patients were discharged the same day. At follow-up, 11 patients complained of recurrent symptoms, five of prolapse, four of bleeding and two of pruritus. Eight patients suffered with post-operative anal fissures. The procedure is recommended by 84.4% of patients 6 weeks post-surgery.

Conclusion

DGHAL–RAR is safe, effective and well tolerated. It reduces the need for potentially dangerous excisional procedures. The RAR component is an effective addition to DGHAL in the short term for the treatment of prolapse, but longer follow-up will be required to demonstrate durability of the technique.

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References

  1. National Institute for Health and Clinical Excellence (2007) Stapled haemorrhoidopexy for the treatment of haemorrhoids. NICE technology appraisal guidance 128

  2. Milligan E, Morgan C (1937) Surgical anatomy of the anal canal and operative treatment of hemorrhoids. Lancet 2:1119–1124

    Article  Google Scholar 

  3. Ferguson JA, Heaton JR (1959) Closed hemorrhoidectomy. Dis Colon Rectum 2:176–179

    Article  CAS  PubMed  Google Scholar 

  4. Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355:782–785

    Article  CAS  PubMed  Google Scholar 

  5. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flow meter. Am J Gastroenterol 90:610–613

    CAS  PubMed  Google Scholar 

  6. Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191:89–93

    Article  PubMed  Google Scholar 

  7. Bursics A, Morvay K, Kupcsulik P, Flautner L (2004) Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis 19:176–180

    Article  PubMed  Google Scholar 

  8. Dal Monte PP, Tagariello C, Sarago M et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338

    Article  CAS  PubMed  Google Scholar 

  9. Wilkerson P, Strbac M, Reece-Smith H, Middleton S (2008) Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction. Colorectal Dis 11:394–400

    Article  PubMed  Google Scholar 

  10. Conaghan P, Farouk R (2009) Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery in patients who fail rubber band ligation treatment. Dis Colon Rectum 52:127–130

    PubMed  Google Scholar 

  11. Sardinha TC, Corman ML (2002) Hemorrhoids. Surg Clin North Am 82:1153–1167, vi

    Article  PubMed  Google Scholar 

  12. Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG (1992) Symptomatic hemorrhoids: current incidence and complications of operative therapy. Dis Colon Rectum 35:477–481

    Article  CAS  PubMed  Google Scholar 

  13. Thomson WH (1975) The nature of haemorrhoids. Br J Surg 62:542–552

    Article  CAS  PubMed  Google Scholar 

  14. Milson JW (1992) Hemorrhoidal disease. In: Beck DE, Wexner SD (eds) Fundamentals of anorectal surgery. Saunders, Philadelphia, pp 192–214

    Google Scholar 

  15. Shanmugam V, Thaha MA, Rabindranath KS, Campbell KL, Steele RJ, Loudon MA (2005) Rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids. Cochrane Database Syst Rev CD005034

  16. Middleton SB, Lovegrove RE, Reece-Smith H (2008) Management of haemorrhoids: symptoms govern treatment. BMJ 336:461

    Article  PubMed  Google Scholar 

  17. Classic articles in colonic and rectal surgery. Frederick Salmon 1796-1868. Dis Colon Rectum 1983; 26:754–758

  18. Muzi MG, Milito G, Nigro C et al (2007) Randomized clinical trial of LigaSure and conventional diathermy haemorrhoidectomy. Br J Surg 94:937–942

    Article  CAS  PubMed  Google Scholar 

  19. Longo A (1998) Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Sixth World Congress of Endoscopic Surgery, Rome, Italy

  20. Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305

    Article  PubMed  Google Scholar 

  21. Shao WJ, Li GC, Zhang ZH, Yang BL, Sun GD, Chen YQ (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 95:147–160

    Article  PubMed  Google Scholar 

  22. Jayaraman S, Colquhoun PH, Malthaner RA (2006) Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev CD005393

  23. Cheetham MJ, Cohen CR, Kamm MA, Phillips RK (2003) A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up. Dis Colon Rectum 46:491–497

    Article  CAS  PubMed  Google Scholar 

  24. Ripetti V, Caricato M, Arullani A (2002) Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids: report of a case and subsequent considerations. Dis Colon Rectum 45:268–270

    Article  PubMed  Google Scholar 

  25. Felice G, Privitera A, Ellul E, Klaumann M (2005) Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 48:2090–2093

    Article  PubMed  Google Scholar 

  26. Faucheron JL, Gangner Y (2008) Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and three-year follow-up results in 100 consecutive patients. Dis Colon Rectum 51:945–949

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Royal Berkshire Hospital, Reading, UK, RG1 5AN

    Neil P. Forrest, Jose Mullerat, Charles Evans & Simon B. Middleton

  2. Department of General Surgery, Royal Berkshire Hospital, Reading, UK, RG1 5AN

    Simon B. Middleton

Authors
  1. Neil P. Forrest
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  2. Jose Mullerat
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  3. Charles Evans
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  4. Simon B. Middleton
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Correspondence to Simon B. Middleton.

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Forrest, N.P., Mullerat, J., Evans, C. et al. Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids. Int J Colorectal Dis 25, 1251–1256 (2010). https://doi.org/10.1007/s00384-010-0951-4

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  • DOI: https://doi.org/10.1007/s00384-010-0951-4

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