Scientific papers–clinical (international)Doppler-guided hemorrhoidal artery ligation
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)
Office ligation of internal hemorrhoids
Am J Surg
(1958)Office ligation of internal hemorrhoids
Am J Surg
(1963)- et al.
Surgical anatomy of the anus and the operative treatment of haemorrhoids
Lancet
(1937) - et al.
A novel therapy for internal hemorrhoidsligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter
Am J Gastroenterol
(1995) - et al.
Pathophysiologie des Hämorrhoidalleidens
Chirurg
(2001) Ambulante Hämorrhoidaltherapie
Chirurg
(2001)
Cited by (123)
The evolving role of THD in hemorrhoids
2019, Seminars in Colon and Rectal SurgeryCitation Excerpt :Several studies in the literature have legitimized the THD® Doppler procedure as an effective non-excisional operation for symptomatic HD.11 The technical improvement and optimization in targeted hemorrhoidal artery ligation2,3,12–14 and the addition of the appropriate MP in those patients presenting with hemorrhoidal/muco-hemorrhoidal prolapse2 have yielded high success rates in treating the symptoms of hemorrhoidal disease (mainly bleeding and prolapse). The reported operating time ranges between 20 and 45 min.
The ligament of Parks as a key anatomical structure for safer hemorrhoidectomy: Anatomic study and a simple surgical note
2017, Annals of Medicine and Surgery