Scientific papers–clinical (international)
Doppler-guided hemorrhoidal artery ligation

https://doi.org/10.1016/j.amjsurg.2005.10.007Get rights and content

Abstract

Background

In 1995, Morinaga [1] reported a new technique for the treatment of hemorrhoids, hemorrhoidal artery ligation (HAL), which uses a specially designed proctoscope coupled with a Doppler transducer for identification and ligation of hemorrhoidal arteries.

Methods

Because the arteries carrying the blood inflow are ligated, internal pressure of the plexus hemorrhoidalis is decreased.

Results

We report the results of the first 308 patients (189 male and 119 female; median age 50.1 years) who have been treated at our department since 2002 and followed-up for a median period of 18 months. Eighty-nine patients had grade II, 192 patients had grade III, and 27 patients had grade IV hemorrhoids. The acute symptoms of hemorrhoids were treated immediately by performing HAL.

Conclusions

Our study showed that HAL is painless, effective, and has a low rate of complications. It can be applied in an outpatient setting and is an good alternative to all other hemorrhoid treatment methods.

Section snippets

Mechanical Explanation

The muscular fibroplastic supportive tissue of the inferior hemorrhoidal plexus (Parks ligament) degenerates with a patient’s age. As a result, the mobility of the plexus increases in relation to the intrarectal pressure. At the same time, the vessels of this plexus become enlarged. The enlarged plexus hemorrhoidalis, plus the increased mobility caused by insufficient supportive structures, are the reason for prolapsing piles. The mucosa becomes more fragile, and bleeding occurs.

Dysfunction of Arteriovenous Shunts

Arteriovenous shunts are usually closed, thus enabling capillary blood exchange. Specific irritation can cause such shunts to open and tissue drops to perfuse. As a result, spasms of the precapillary sphincters occur, and flow through the shunts increases. This leads to high interior pressure and dilation of the hemorrhoidal venous plexus. It also explains the bright red color of the blood presented by bleeding hemorrhoids.

Today, hemorrhoidal disease is considered a typical “civilization”

Modalities of Treating Hemorrhoids

Therapeutic treatment of hemorrhoidal disease ranges from diet to medication. For example, the literature [5], [6] shows that Daflon has a positive influence on the bleeding tendency of grade I hemorrhoids. According to Blaisdell [7] and Barron [8], infrared coagulation [4], sclerotherapy, and, particularly, rubber-band ligation are generally accepted and popular procedures that have generated good results and low complication rate in grades II and III hemorrhoids. The disadvantages of these

Methods

In 1995, Morinaga described a new technique forthe treatment of hemorrhoids [1]. The intraluminal arteries are located 2 cm proximal to the dentate line and ligated by means of a special proctoscope, which contains an integrated Doppler transducer and a lateral ligation window. The Doppler transducer is located distal to the lateral ligation window. With the applied frequency of 8.2 Mhz and an introduction angle of approximately 60°, a screening depth of approximately 7 mm is provided. Because

Results

From January 2000 through December 2002, 308 patients were treated by Doppler-guided HAL. The group consisted of 189 male and 119 female patients (age 22 to 84 years; median age 50.1 years). Main symptoms when consulting a physician were anal pain, bleeding, and prolapsing piles (Table 1). A positive Hemoccult test led to the transfer of 1 patient to our surgical department.

The method was applied to 89 patients with grade II, to 192 patients with grade III, and to 27 patients with grade IV

Comments

We believe that Doppler-guided HAL is a painless, easily learned, and minimally invasive therapeutic technique that offers a good alternative to all other known treatments of symptomatic hemorrhoids. All stages of hemorrhoidal disease can be treated using HAL. There is always the possibility of revascularization and recurrence of symptomatic hemorrhoids, but this procedure can be repeated at any time. Furthermore, it is possible at any time after HAL to switch to another procedure such as

References (13)

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