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Published on: December 4, 2023
Doppler-guided hemorrhoidal artery ligation: the experience of a single institution
Ursula Maria Szmulowicz1, Brooke Gurland, Thomas Garofalo
1Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. szmulou@ccf.org
Purpose:
This study aims to review the short-term recurrence and complications of Doppler-guided hemorrhoidal artery ligation (DG-HAL) with mucopexy.
Methods:
Approval was obtained for a retrospective chart review of patients who underwent DG-HAL from January 2007 to June 2009. A treatment failure was recorded if internal hemorrhoids were noted at follow up or symptoms persisted. All recurrences were assessed for predictive factors.
Results:
The procedures were performed by four surgeons. Ninety-six patients were included. The average age was 63.5 years (21-81 years). The mean follow up was 15 months (3-35 months). Of the patients, 93 (96.8%) reported bleeding pre-operatively. Mucopexy accompanied DG-HAL in 87 (90.6%). Postoperative complications occurred in nine (9%) patients. Residual hemorrhoids were evident in 20 (21%) patients, 13 of whom required further management for symptomatic disease, five with DG-HAL. Fifty percent (10/20) and 70% (9/13) of the recurrences necessitating further treatment transpired during the first 20 procedures of each surgeon. All 13 symptomatic recurrences demonstrated large, circumferential internal hemorrhoids.
Conclusions:
DG-HAL is a simple procedure with a low complication rate. Recurrences are more frequent during the learning curve. Patients with large, circumferential internal hemorrhoids should be counseled about a possible higher rate of recurrence. DG-HAL can be effectively repeated for recurrences.
