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Is Doppler ultrasonography essential for hemorrhoidal artery ligation?
1Department of Surgery 'A', Tel-Aviv Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, 6 Weitzman Street, 64239, Tel-Aviv, Israel.
Techniques in Coloproctology
|June 2, 2012
Summary
Doppler ultrasonography may not be essential for hemorrhoidal artery ligation (HAL). Arterial branches are consistently located, suggesting a potential to forgo ultrasound in some HAL procedures.
Area of Science:
- Colorectal Surgery
- Vascular Anatomy
- Minimally Invasive Procedures
Background:
- Doppler ultrasonography aids in identifying superior rectal artery branches for hemorrhoidal artery ligation (HAL).
- The consistent anatomical positions of these arterial branches raise questions about the routine necessity of preoperative ultrasonography.
Purpose of the Study:
- To evaluate the necessity of Doppler ultrasonography in hemorrhoidal artery ligation (HAL).
- To examine the precise anatomical positions of all ligated arteries during the HAL procedure.
Main Methods:
- Recorded the positions of all identified and ligated arteries in 135 consecutive patients undergoing HAL.
- Data collected between 2003 and 2006.
Main Results:
- 6-8 terminal arterial branches were consistently found above the dentate line in all patients.
- In 76% of patients, branches were present at all odd-numbered clock positions (1, 3, 5, 7, 9, 11).
- Ligating only at odd-numbered positions without ultrasound would have missed at least one artery in 29% of patients.
Conclusions:
- The number and location of superior rectal artery branches are relatively constant.
- Relying solely on odd-numbered clock positions for ligation without Doppler ultrasonography could lead to missed arteries in a significant portion of patients.
