title: Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids.
abstract: OBJECTIVE
  Doppler-guided haemorrhoidal artery ligation (DGHAL) is a minimally invasive surgical technique used to treat symptomatic haemorrhoids. In 2005, the DGHAL proctoscope was redesigned to incorporate a window through which a recto anal repair (RAR) could be performed to improve the outcome in patients with significant prolapse symptoms. The aim of this study was to observe the outcome of a series of consecutive DGHAL-RAR procedures.
  
  
  METHODS
  Seventy-seven consecutive patients (49 male) underwent DGHAL-RAR for symptomatic haemorrhoids and were reviewed for a minimum of 6 months post-surgery.
  
  
  RESULTS
  Fifty-seven (74%) of patients presented with both prolapse and bleeding symptoms. The median number of DGHALs performed was six, and the median number of RARs was two. Most (96%) patients were discharged the same day. At follow-up, 11 patients complained of recurrent symptoms, five of prolapse, four of bleeding and two of pruritus. Eight patients suffered with post-operative anal fissures. The procedure is recommended by 84.4% of patients 6 weeks post-surgery.
  
  
  CONCLUSIONS
  DGHAL-RAR is safe, effective and well tolerated. It reduces the need for potentially dangerous excisional procedures. The RAR component is an effective addition to DGHAL in the short term for the treatment of prolapse, but longer follow-up will be required to demonstrate durability of the technique.
authors.affiliation: Royal Berkshire Hospital, Reading, UK.
authors.forename: Neil P
authors.initials: NP
authors.lastname: Forrest
authors.forename: Jose
authors.initials: J
authors.lastname: Mullerat
authors.forename: Charles
authors.initials: C
authors.lastname: Evans
authors.forename: Simon B
authors.initials: SB
authors.lastname: Middleton
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D005401:Fissure in Ano / Q000209:etiology; D006470:Hemorrhage / Q000209:etiology; D006484:Hemorrhoids / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged; D020700:Proctoscopes; D011391:Prolapse; D011537:Pruritus / Q000209:etiology; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D014656:Vascular Surgical Procedures / Q000295:instrumentation / Q000379:methods*
references.citation: Dis Colon Rectum. 2007 Sep;50(9):1297-305
references.pmid: 17665254
references.citation: Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005393
references.pmid: 17054255
references.citation: Tech Coloproctol. 2007 Dec;11(4):333-8; discussion 338-9
references.pmid: 18060529
references.citation: Br J Surg. 2007 Aug;94(8):937-42
references.pmid: 17636512
references.citation: Lancet. 2000 Mar 4;355(9206):782-5
references.pmid: 10711925
references.citation: Dis Colon Rectum. 1959 Mar-Apr;2(2):176-9
references.pmid: 13652788
references.citation: Dis Colon Rectum. 2008 Jun;51(6):945-9
references.pmid: 18219528
references.citation: Dis Colon Rectum. 2009 Jan;52(1):127-30
references.pmid: 19273967
references.citation: Dis Colon Rectum. 1983 Nov;26(11):754-8
references.pmid: 6354647
references.citation: Surg Clin North Am. 2002 Dec;82(6):1153-67, vi
references.pmid: 12516845
references.citation: Dis Colon Rectum. 2002 Feb;45(2):268-70
references.pmid: 11852343
references.citation: Br J Surg. 2008 Feb;95(2):147-60
references.pmid: 18176936
references.citation: BMJ. 2008 Mar 1;336(7642):461
references.pmid: 18309968
references.citation: Dis Colon Rectum. 2005 Nov;48(11):2090-3
references.pmid: 16228837
references.citation: Dis Colon Rectum. 2003 Apr;46(4):491-7
references.pmid: 12682543
references.citation: Colorectal Dis. 2009 May;11(4):394-400
references.pmid: 18573116
references.citation: Dis Colon Rectum. 1992 May;35(5):477-81
references.pmid: 1568400
references.citation: Br J Surg. 1975 Jul;62(7):542-52
references.pmid: 1174785
references.citation: Am J Gastroenterol. 1995 Apr;90(4):610-3
references.pmid: 7717320
references.citation: Cochrane Database Syst Rev. 2005 Jul 20;(3):CD005034
references.pmid: 16034963
references.citation: Int J Colorectal Dis. 2004 Mar;19(2):176-80
references.pmid: 12845454
references.citation: Am J Surg. 2006 Jan;191(1):89-93
references.pmid: 16399113