Comparison of Doppler-guided haemorrhoidal artery ligation without mucopexy and rubber band ligation for haemorrhoids.
OBJECTIVE
Recurrences after Doppler-guided haemorrhoidal artery ligation (DG-HAL) tend to occur in patients with concurrent mucosal prolapse. We retrospectively compared the results of DG-HAL and rubber band ligation (RBL) for the treatment of haemorrhoidal disease.


METHODS
From 2005 to 2009, all patients who underwent either a DG-HAL procedure or RBL were selected. Follow-up was done by telephone using a standardised questionnaire survey to assess patient satisfaction and complaints. When recurrent disease was suspected, patients revisited the clinic for further examination and treatment.


RESULTS
A total of 239 DG-HAL patients and 47 RBL patients were analysed. Sixty-seven percent in the DG-HAL group and 79% in the RBL group had an improvement in symptoms after one treatment (p=0.22). Forty-six DG-HAL patients (19%) needed a second procedure versus three patients (6%) in the RBL group (p<0.05). Cox regression analysis showed a significant difference in disease recurrence in favour of RBL (hazard ratio (HR) 3.71, 95% confidence interval (CI) 1.13-12.2). Patients in the DG-HAL group with recurrent haemorrhoids had a higher incidence of mucosal prolapse.


CONCLUSIONS
DG-HAL seems very effective in treating lower-grade haemorrhoids. In more advanced disease, recurrence occurs due to persisting mucosal prolapse. RBL seems much more effective in reducing the prolapse and the chance of recurrence.
Department of Surgery, Deventer Hospital, Deventer, The Netherlands. pol.chirurgie@gmail.com
Robert A
RA
Pol
Wil C
WC
van der Zwet
Mirjam
M
Kaijser
Marinus Eeftinck
ME
Schattenkerk
Eric-Hans
EH
Eddes
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000601:surgery*; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000601:surgery; D053208:Kaplan-Meier Estimate; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011391:Prolapse; D016016:Proportional Hazards Models; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D018608:Ultrasonography, Doppler; D018084:Ultrasonography, Interventional