PURPOSE: This study was designed to assess whether Doppler-guided hemorrhoid artery ligation can prevent patients from needing conventional surgery when rubber band ligation of their hemorrhoids has failed to achieve symptomatic relief. METHODS: All patients who underwent treatment for hemorrhoids in two hospitals between September 2004 and June 2007 are reported. RESULTS: A total of 203 patients (121 women; mean age, 44 (range, 17-84) years) were treated by rubber band ligation for two (181 patients) or three hemorrhoids (22 patients) during the study period. Fifty-four of these patients (27 percent) continued to suffer symptoms of bleeding (38 patients) or bleeding and prolapse (16 patients) after three clinic assessments. Fifty-two of these 54 patients subsequently underwent Doppler-guided hemorrhoid artery ligation. Two other patients had stapled anopexy. After a median follow-up of 18 (range, 6-33) months, 12 of the 52 patients (23 percent) who underwent Doppler-guided hemorrhoid artery ligation have returned with recurrent symptoms of bleeding (6 patients) and/or prolapse (6 patients). Four patients with recurrent symptoms were treated by single quadrant hemorrhoidectomy, and the remaining eight underwent Doppler-guided hemorrhoid artery ligation with rectoanal repair. CONCLUSION: Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery where rubber band ligation has been unsuccessful.
PURPOSE: This study was designed to assess whether Doppler-guided hemorrhoid artery ligation can prevent patients from needing conventional surgery when rubber band ligation of their hemorrhoids has failed to achieve symptomatic relief. METHODS: All patients who underwent treatment for hemorrhoids in two hospitals between September 2004 and June 2007 are reported. RESULTS: A total of 203 patients (121 women; mean age, 44 (range, 17-84) years) were treated by rubber band ligation for two (181 patients) or three hemorrhoids (22 patients) during the study period. Fifty-four of these patients (27 percent) continued to suffer symptoms of bleeding (38 patients) or bleeding and prolapse (16 patients) after three clinic assessments. Fifty-two of these 54 patients subsequently underwent Doppler-guided hemorrhoid artery ligation. Two other patients had stapled anopexy. After a median follow-up of 18 (range, 6-33) months, 12 of the 52 patients (23 percent) who underwent Doppler-guided hemorrhoid artery ligation have returned with recurrent symptoms of bleeding (6 patients) and/or prolapse (6 patients). Four patients with recurrent symptoms were treated by single quadrant hemorrhoidectomy, and the remaining eight underwent Doppler-guided hemorrhoid artery ligation with rectoanal repair. CONCLUSION: Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery where rubber band ligation has been unsuccessful.