Preliminary experience with doppler guided hemorrhoidal artery ligation for management of hemorrhoids

Reda Ez, PhD

Ain Shams university, Cairo Egypt

Purpose: This study is to present our preliminary experience of the Doppler-guided hemorrhoidal artery ligation after operating 185 cases of symptomatic hemorrhoids

Methods:
the study included 185 cases of hemorrhoids .one hundred twenty six patients had 3rd degree piles,33 patients had 2nd degree and twenty six had 4th degree piles. Ninety eight cases were operated using KM25 doppler device,82 cases operated using THD device and 5 cases using the hemodop device.
A Doppler probe incorporated proctoscope was inserted under the lithotomy position and the location
of the hemorrhoidal artery was identified. The identified artery was ligated as a ‘figure of eight’ method with
an absorbable suture into the submucosa. In 63 cases rectanal repair (RAR) was added to the ligation when a significant prolapse was detected. In such cases the prolapsed hemorrhoidal pile was lifted at the rectal mucosa by continuous suture to 5 mm above the dentate line and tied. The procedure was repeated at the 1, 3, 5, 7, 9, and 11 o’clock positions. We evaluated post-operative hospital stay, degree of pain, time to return to work,and other complications including recurrence.

Results: The patient’s mean age was 42 years and the follow-up period is between 3 months to 3 years.The
degree of internal hemorrhoids was as follows: Grade II: 33, Grade III: 126, and Grade IV:
26. The mean operation time was 35 minutes and post-operative hospital stay was 1.1 days. The mean time it
took to return to work was 1.8 days. There were no major complications and recurrence occurred in 17 cases. Pain and bleeding occurred in 25 cases having RAR.

Conclusion: The DG-HAL is safe ,effective and less painful procedure for the treatment of symptomatic hemorrhoids. Complications increase if the DGHAL is combined with RAR. Gaining experience and following some technical tricks improve the results and diminish complications


Session: Poster Presentation

Program Number: P481

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