Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction.
OBJECTIVE
Conventional Milligan-Morgan haemorrhoidectomy is associated with significant pain and potentially hazardous complications. Doppler-Guided Haemorrhoidal Artery Ligation (DGHAL) may offer a lower risk, pain-free alternative. We present our early and long-term outcome experience with DGHAL, combined with patient views and satisfaction with the procedure.


METHODS
One hundred and thirteen DGHALs were performed over a 13 month period by two surgeons in a single centre. Patients graded the severity of postoperative pain on visual-analogue scales. Clinical follow-up was at 6 weeks (n = 103), with long-term follow-up (n = 90) by postal questionnaire at median of 30 months.


RESULTS
Seven out of one hundred and three (6%) patients reported postoperative discomfort requiring analgesia. Ninety-three out of one hundred and three (90%) patients reported complete relief or significant improvement in their symptoms at 6 weeks, dropping to 77/90 (86%) at 30 months. Anal fissures developed in 2/103 (2%) patients, both treated with Diltiazem ointment. Further surgery was required in 8/90 (9%) patients. Eighty-two out of ninety (91%) patients said they would undergo DGHAL again.


CONCLUSIONS
DGHAL is a relatively painless, safe, and effective procedure for symptomatic stage I-III haemorrhoids, for which we have demonstrated long-term durability and acceptability. Its role lies between office based procedures and more invasive operative interventions.
Wilkerson
P M
PM
Department of Colorectal Surgery, Royal Berkshire and Battle Hospitals, NHS Trust, Reading, UK. pmwilkerson@doctors.org.uk
Strbac
M
M
Reece-Smith
H
H
Middleton
S B
SB
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000000981:diagnostic imaging* / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D020127:Recovery of Function; D018084:Ultrasonography, Interventional; D055815:Young Adult