Ligation under vision of haemorrhoidal cushions for therapy of bleeding haemorrhoids

Ligation under vision (LUV) is a simple method for the surgical treatment of haemorrhoids. In this study, we evaluated the results of our initial experience with the procedure in terms of postoperative pain, patients' final satisfaction and complications. We reviewed a group of patients who had undergone suture ligation of symptomatic haemorrhoids of grade II and III. This was performed with the haemorrhoids under direct vision and without the use of any ancillary instrumentation such as a Doppler sensor. All interventions were performed in the day-care surgical unit using general or regional anaesthesia. Surgical outcome and degree of postoperative pain were determined from outpatient clinic follow-up and individual phone interviews. A total of 32 patients (19 men and 13 women) with a mean age of 59 years had undergone LUV. There were 23 patients (72%) with grade II and 9 patients (28%) with grade III haemorrhoids. The indication for the surgery was bleeding in 19 patients (59%), prolapse in 6 (19%) and both in 7 (22%). A previous rubber band ligation had been carried out in 17 patients (53%). On average, the surgery took 22 min. All patients were discharged on the same day. Four %patients (12%) suffered only mild postoperative pain, 14 (44%) suffered from moderate pain and another 14 (44%) had severe pain. At follow-up (median 21 months, range 9-33 months), 28 %patients (87.5%) were completely asymptomatic at the time of the phone interview. The final result was assessed as excellent by 19 patients (60%), successful by 10 (31%), and unsuccessful by 3 (9%). All patients had complete functional recovery and there were no major surgical complications. Our data show that LUV of symptomatic haemorrhoids is a simple and safe procedure. It can be performed as effective isolated surgery for symptomatic haemorrhoids and as an additional procedure in the treatment of complex perianal pathology.