One year follow-up after doppler-guided haemorrhoidal artery ligation

The Doppler-guided haemorrhoidal artery ligation (DG-HAL) is a non-exeresis technique for the treatment of haemorrhoids, consisting in the ligature of the distal branches of the upper rectal artery. The aim of this work is to evaluate the safety and efficacy of this technique after one year of follow-up. A total of 30 patients were operated on using DG-HAL for grade II or III haemorrhoids. The mean age was 49.9 years (30-70 years). The THD® (Transanal Haemorrhoidal Dearterialisation) device was employed in all cases. The procedures were performed under intradural anaesthesia in a short-stay surgery unit. The operating time, pain, bleeding, postoperative stay, and complications and symptoms after 3-6 months and 12 months were recorded. The mean operating time was 23minutes (15-50). The pain according to a visual analogue scale (VAS) was 5.5 during the first day (90% required analgesia). Only 2 patients required analgesia after the second day. One patient described persistent pain up to 3 months, and 2 slight bleeding. A further operation was performed due to a haemorrhoidal thrombosis on the 10(th) day. There were no other complications and no re-admissions. The mean hospital stay was 1.4 days (0-2), and normal daily activity re-established at 7-8 days. A large majority (87%) of patients described having tenesmus, which disappeared in 3 months. After one year, two patients had had further operations, 3 had recurrences (2 slight prolapses and 1 occasional bleeding). The success rate was 80%. Haemorrhoidal dearterialisation using Doppler-guided arterial ligation seems to be effective after one year, with a low percentage of complications.