J Korean Surg Soc.  2010 Aug;79(2):116-121. 10.4174/jkss.2010.79.2.116.

Early Experience of Treatment for Symptomatic Hemorrhoids with Doppler Guided Hemorrhoidal Artery Ligation and Recto-anal Repair

• Jo BH
• Park JK
• Lee IK
• Kim HJ
• Lee YS
• Lee JI
• Kim SH
• Kang WK

• KMID: 2211981
• DOI: http://doi.org/10.4174/jkss.2010.79.2.116

Abstract

PURPOSE
Despite all developments in recent years, the choice of an adequate treatment for hemorrhoids remains a problem. Hemorrhoidal artery ligation and recto-anal repair (HAL-RAR) is a nonexcisional surgical technique for the treatment of hemorrhoids, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the hemorrhoidal plexus. The aim of this study was to present the early experience of treating hemorrhoids with HAL-RAR.
METHODS
Between December 2008 and November 2009, 70 consecutive patients with symptomatic hemorrhoids were treated with HAL-RAR. The patients underwent sonographic identification and suture ligation of 4 to 8 terminal branches of the superior rectal artery above the dentate line.
RESULTS
There were 33 males and 37 females (mean age, 49.72+/-14.1 years). The mean operative time was 43.8 minutes (25~80 min). Most patients (=61, 87%) were without any complaint upon follow-up at 1 week. Nine patients presented with early complication: isolated pain in 1, anemia in 1, isolated bleeding in 1, voiding difficulty (over 1 day) in 2 and tenesmus (over 2 weeks) in 4.
CONCLUSION
Based on our results we may conclude that HAL-RAR is a minimally invasive, safe and effective method and may offer an important alternative for the treatment of hemorrhoids. It may offer minimally postoperative pain, and early return of patients to their normal activities.

Keyword

Hemorrhoid; Hemorrhoidal artery ligation (HAL); Doppler

MeSH Terms

Anemia
Arteries
Female
Follow-Up Studies
Hemorrhage
Hemorrhoids
Humans
Ligation
Male
Operative Time
Pain, Postoperative
Sutures

Figure

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  Fig. 1 Photograph of instrument used in hemorrhoidal artery ligation (HAL) procedure.

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  Fig. 2 Schematic illustration of the hemorrhoidal artery ligation (HAL)-Doppler proctoscope in the anal canal during ligation.

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  Fig. 3 Preoperative appearance of anus of 58-year-old patient suffering from protruding hemorrhoid & mucosal edema.

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  Fig. 4 Postoperative appearance of anus that shows complete disappearance of bulging hemorrhoid.

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  Fig. 5 Postoperative day 9 proctoscopic appearance of anus that shows some remaining stitches and decongested hemorrhoid.

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