Results of 244 consecutive patients with hemorrhoids treated with Doppler-guided hemorrhoidal artery ligation.
OBJECTIVE
This study was designed to determine the effect of treating hemorrhoids with the Doppler-guided hemorrhoidal artery ligation (DG-HAL) procedure.


METHODS
From June 2005 to March 2008, 244 consecutive hemorrhoidal patients underwent hemorroidal artery ligation performed with the DG-HAL system from AMI. All patients were evaluated postoperatively with a proctologic examination and interview. Further follow-up was performed by telephone with a standardized questionnaire. When indicated, patients revisited the clinic for further examination and treatment.


RESULTS
244 patients were treated with DG-HAL. The mean follow-up time was 18.4 months (range 1.4-37.2). Sixty-seven percent of the patients had an improvement of symptoms after one treatment. Fifty-three patients (22%) underwent a second procedure because of persisting symptoms. Thirteen patients (25%) underwent a second DG-HAL and 40 (75%) underwent rubber band ligation. In total, 69% of the patients had a good response using the DG-HAL technique. Multivariate logistic regression analysis revealed prolapse to be an independent risk factor for persistent symptoms (OR = 2.38, 95% CI 1.10-5.15). Patients with grades 3 and 4 hemorrhoids had a higher risk of developing recurrent disease (OR = 4.94, 95% CI 0.67-36.42).


CONCLUSIONS
DG-HAL seems to be an effective procedure for treating low-grade hemorrhoids. A resection procedure should be the treatment for patients with recurrent disease.
Pol
Robert A
RA
Department of Surgery, Deventer Hospital, Deventer, The Netherlands. r.pol@dz.nl
van der Zwet
Wil C
WC
Hoornenborg
Daniel
D
Makkinga
Babbeth
B
Kaijser
Miriam
M
Eeftinck Schattenkerk
M
M
Eddes
Eric-Hans
EH
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D015331:Cohort Studies; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008026:Ligation / Q000379:methods; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D015999:Multivariate Analysis; D010149:Postoperative Pain / Q000503:physiopathology; D017060:Patient Satisfaction; D012007:Rectum / Q000098:blood supply* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional; D014656:Vascular Surgical Procedures / Q000379:methods*