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Outcomes of Doppler-guided hemorrhoid artery ligation: analysis of 90 consecutive patients
M Spyridakis1, G Christodoulidis, D Symeonidis
1Department of General Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece.
Insights
Doppler-guided hemorrhoid artery ligation (DG-HAL) is a safe and effective treatment for hemorrhoidal disease, with low complication and recurrence rates observed one year post-operation.
Area of Science:
- Colorectal Surgery
- Minimally Invasive Procedures
- Gastroenterology
Background:
- Hemorrhoidal disease affects a significant portion of the population.
- Doppler-guided hemorrhoid artery ligation (DG-HAL) offers a minimally invasive surgical option.
- Evaluating the efficacy and safety of DG-HAL is crucial for patient management.
Purpose of the Study:
- To assess the early and long-term outcomes of Doppler-guided hemorrhoid artery ligation.
- To determine complication and recurrence rates one year after DG-HAL.
- To evaluate DG-HAL as a treatment for all grades of hemorrhoidal disease.
Main Methods:
- A prospective study included 90 patients undergoing DG-HAL over 4 years.
- Procedures were performed under spinal anesthesia or local perianal block.
- Data collected included postoperative stay, analgesic use, complications, and recurrence rates.
Main Results:
- The mean operative time was 26 minutes.
- Most patients (64.4%) were discharged on the same day.
- Early and late complications were low (4.4% and 3.3% respectively), with a 6.6% recurrence rate at one year.
Conclusions:
- Doppler-guided hemorrhoid artery ligation demonstrates safety and effectiveness across all grades of hemorrhoidal disease.
- DG-HAL appears to be a valuable addition to the surgical options for hemorrhoids.
- Further randomized comparative studies are recommended to solidify the role of DG-HAL.
Background:
Doppler-guided hemorrhoid artery ligation is a minimal-invasive surgical treatment option for hemorrhoidal disease. The aim of our study was to evaluate the early and long-term results of the procedure 1 year after the operation.
Patients And Methods:
In a period of 4 years, 90 patients were included in this study. The Doppler-guided hemorrhoid artery ligation was performed under either spinal anesthesia or local perianal block. We recorded the length of postoperative inpatient care, on-demand analgesics administered apart from the standard analgesic protocol, short- and long-term complications, and, finally, recurrences.
Results:
The mean age of patients was 46 ± 12.6 years. The operation was performed under spinal anesthesia in 82 patients and under local perianal block in 8 patients. The mean operative time was 26 ± 4.1 min. On-demand analgesics administration was reported in sixteen patients (17.7%) the first postoperative day and in four patients (4.4%) the second postoperative day. A total of 58 patients (64.4%) were discharged from the hospital the day of the operation, 29 (32.2%) patients stayed overnight, and in three (3.3%) patients, a hospitalization period of 2 days was needed. Four patients (4.4%), two with grade III and two with grade IV hemorrhoids, developed early postoperative complications. Late complications were observed in three patients (3.3%). Recurrences, manifested either as bleeding or as prolapsing piles, were observed in six patients (6.6%), two patients with initial grade III and four with grade IV hemorrhoids.
Conclusion:
Doppler-guided hemorrhoid artery ligation seems to be a safe and effective treatment option for all grades of hemorrhoidal disease. Further prospective randomized comparative studies are needed in order to fully evaluate the true role of DG-HAL in the surgical armamentarium.
