Doppler Guided Hemorrhoidal Artery Ligation A Minimally Invasive Treatment for Symptomatic Hemorrhoids

Stefan S., Gumber A., Naqvi S. et al.
World J Surg Surgical Res. 2019; 2: 1174

Hemorrhoids remain one of the commonest conditions affecting humans. Excisional hemorrhoidectomy is classified as the best treatment for this pathology, with lower postoperative recurrence rates; however it is associated with significant morbidity. This study aims to evaluate the outcomes of Doppler guided hemorrhoidal artery ligation for the symptomatic grade III/IV hemorrhoids.

Over a period of 7 years (2010-2016) all patients having a Transanal Hemorrhoidal Artery Dearterialisation (THD) procedure by a single surgeon were included in this single centre cohort study. Patient demographics, operative outcomes and long-term results were recorded. Assessments were carried out at 3 weeks, 2 months, then at 2 years periods for symptom evaluation.

136 patients underwent THD procedure at this centre. 58% were men with a median BMI of 26. Rectal bleeding was the commonest presenting complaint. Over 75% patients received officebased procedures prior to THD. THD was successfully carried out in all patients. Majority of procedures were performed as day case and 13% patients required an overnight stay. There were no complications in 73% of patients. Reported postoperative complications included constipation, urinary retention, anal fissure, skin tags, bleeding and perianal hematoma (Figure 3). Sustained symptomatic improvement was seen across four domains (bleeding, pain, itching and soiling) at 2 months and 2 years (Figure 4).

THD remains an effective and successful treatment option for the management of symptomatic hemorrhoids. Faster post-operative recovery and acceptable long-term results make this an attractive option for patients with medium to large hemorrhoids.