J Korean Surg Soc.  2010 Jan;78(1):23-28. 10.4174/jkss.2010.78.1.23.

Early Experience of Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal Repair (DG-HAL & RAR) for the Treatment of Symptomatic Hemorrhoids

• Cho SW
• Lee RA
• Chung SS
• Kim KH

• KMID: 1775441
• DOI: http://doi.org/10.4174/jkss.2010.78.1.23

Abstract

PURPOSE: This study is to introduce our preliminary experience of the Doppler-guided hemorrhoidal artery ligation and Rectoanal repair (DG-HAL & RAR) as a new treatment for symptomatic or prolapsed hemorrhoids.
METHODS
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. Then 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 recurrence.
RESULTS
The patient's mean age was 50.2+/-15 years old and the mean follow-up time was 415+/-75 days. The constitution of the type of internal hemorrhoids was as follows: Grade II: 13, Grade III: 16, and Grade IV: 5. The mean operation time was 35 minutes and post-operative hospital stay was 1.4 days. The mean time it took to return to work was 1.8 days. There were no severe pains requiring injection of analgesics or other severe complications. So far, 2 patients have had recurrence of symptoms.
CONCLUSION
The DG-HAL & RAR is a safe and less painful procedure. The DG-HAL & RAR is an effective alternative for the treatment of symptomatic or prolapsed hemorrhoids.

Keyword

Symptomatic hemorrhoids; Doppler-guided hemorrhoidal artery ligation; Recto-anal repair

MeSH Terms

Analgesics
Arteries
Constitution and Bylaws
Follow-Up Studies
Hemorrhoids
Humans
Length of Stay
Ligation
Mucous Membrane
Proctoscopes
Recurrence
Return to Work
Sutures
Analgesics

Figure

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  Fig. 1 Anoscope with an incorporated Doppler probe and sleeve.

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  Fig. 2 Schematic illustration of the Rectoanal repair (mucopexy).

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  Fig. 3 Comparison between pre-operation and post-operation in prolapsed hemorrhoids.

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