title: Five-year follow-up of Doppler-guided hemorrhoidal artery ligation.
abstract: BACKGROUND
  Doppler-guided hemorrhoidal artery ligation (DGHAL) was described as lower risk and a less painful alternative to hemorrhoidectomy. We report our experience and 5-year follow-up with this procedure.
  
  
  METHODS
  Between May 2003 and December 2004, 100 patients with symptomatic Grade II or III hemorrhoids underwent ultrasound identification and ligation of 6-8 terminal branches of the superior rectal artery above the dentate line by a single surgeon using local, regional, or general anesthesia. There were 42 men and 58 women (mean age 42 years, median duration of symptoms 6/3 years). A 10-point visual analog scale was used for postoperative pain scoring. Surgical and functional outcome was assessed at 6 weeks and 3 and 12 months after surgery, with long-term follow-up by a telephone questionnaire at 5 years after the procedure.
  
  
  RESULTS
  The mean operative time was 19 min. Local anal block combined with intravenous sedation (n = 93) or general or spinal (n = 7) anesthesia was used. Only 5 patients were hospitalized overnight. There was no urinary retention, bleeding, or mortality in the immediate postoperative period. The mean pain score decreased from 2.1 at 2 h postoperatively to 1.3 on the first postoperative day. All patients had complete functional recovery by the third postoperative day. Ninety-six patients completed 12 months of follow-up. Eighty-five of these patients (89%) remained asymptomatic at 12 months, though this number dropped to 67/92 (73%) at 5 years.
  
  
  CONCLUSIONS
  Long-term follow-up confirms the effectiveness of the DGHAL procedure for treatment for Grade II hemorrhoids. The DGHAL procedure alone seems less effective for Grade III hemorrhoids.
authors.affiliation: Department of Surgery A, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, 6 Weitzman Street, 64239, Tel Aviv, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Avital
authors.forename: R
authors.initials: R
authors.lastname: Inbar
authors.forename: E
authors.initials: E
authors.lastname: Karin
authors.forename: R
authors.initials: R
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D012007:Rectum / Q000098:blood supply / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional