title: Doppler-guided hemorrhoidal artery ligation: the experience of a single institution.
abstract: OBJECTIVE
  This study aims to review the short-term recurrence and complications of Doppler-guided hemorrhoidal artery ligation (DG-HAL) with mucopexy.
  
  
  METHODS
  Approval was obtained for a retrospective chart review of patients who underwent DG-HAL from January 2007 to June 2009. A treatment failure was recorded if internal hemorrhoids were noted at follow up or symptoms persisted. All recurrences were assessed for predictive factors.
  
  
  RESULTS
  The procedures were performed by four surgeons. Ninety-six patients were included. The average age was 63.5 years (21-81 years). The mean follow up was 15 months (3-35 months). Of the patients, 93 (96.8%) reported bleeding pre-operatively. Mucopexy accompanied DG-HAL in 87 (90.6%). Postoperative complications occurred in nine (9%) patients. Residual hemorrhoids were evident in 20 (21%) patients, 13 of whom required further management for symptomatic disease, five with DG-HAL. Fifty percent (10/20) and 70% (9/13) of the recurrences necessitating further treatment transpired during the first 20 procedures of each surgeon. All 13 symptomatic recurrences demonstrated large, circumferential internal hemorrhoids.
  
  
  CONCLUSIONS
  DG-HAL is a simple procedure with a low complication rate. Recurrences are more frequent during the learning curve. Patients with large, circumferential internal hemorrhoids should be counseled about a possible higher rate of recurrence. DG-HAL can be effectively repeated for recurrences.
authors.affiliation: Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA. szmulou@ccf.org
authors.forename: Ursula Maria
authors.initials: UM
authors.lastname: Szmulowicz
authors.forename: Brooke
authors.initials: B
authors.lastname: Gurland
authors.forename: Thomas
authors.initials: T
authors.lastname: Garofalo
authors.forename: Massarat
authors.initials: M
authors.lastname: Zutshi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D012007:Rectum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*; D018084:Ultrasonography, Interventional; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult