title: Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids.
abstract: OBJECTIVE
  The aim of this study is to clinically test the efficacy of a new approach for patients having symptomatic grade III and IV hemorrhoids.
  
  
  METHODS
  32 patients (17 females) complaining of grade III or IV hemorrhoids were included in the study. A specially designed proctoscope coupled with a Doppler transducer on its tip was used to identify the hemorrhoidal arteries, which were afterwards suture ligated. Operating time as well as per- and post-operative complications were analyzed. Follow-up was planned following discharge after 1 week, 1 month, 6 months and 1 year.
  
  
  RESULTS
  Mean operation time was 27 (range 18-43) minutes, and 5 (range 4-7) arteries were located on average. No patient had severe or moderate postoperative pain, with anal discomfort being the main complaint. Rectal bleeding and tenesmus were the commonest post-operative complications. After one year of follow-up, 19 patients were free of symptoms and 6 of them had significant symptom relief. According to grade, the technique failed in just 3 grade III patients, but in as many as 4 grade IV hemorrhoid cases.
  
  
  CONCLUSIONS
  Doppler-guided hemorrhoid artery ligation is an easy-to-perform technique that is well accepted by patients and has good results for grade III hemorrhoids.
authors.affiliation: Section of Coloproctology, Service of Surgery B, Hospital Clínico Universitario, Zaragoza, Spain. jramirez@unizar.es
authors.forename: J M
authors.initials: JM
authors.lastname: Ramírez
authors.forename: V
authors.initials: V
authors.lastname: Aguilella
authors.forename: M
authors.initials: M
authors.lastname: Elía
authors.forename: J A
authors.initials: JA
authors.lastname: Gracia
authors.forename: M
authors.initials: M
authors.lastname: Martínez
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D018608:Ultrasonography, Doppler