Published in:
01-07-2006 | Letters to the Editor
Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy
Published in: Diseases of the Colon & Rectum | Issue 7/2006
Login to get accessExcerpt
To the Editor—We enjoyed reading the article by Felice et al.1 We performed a total of 188 hemorrhoidal artery ligation (HAL) procedures from 2001 until August 2004. Results at 6 to 12 weeks postoperatively were promising (improvement in 170/183 patients (93 percent)). However, when we analyzed patients at one year postoperatively, the results were disappointing. More than 25 percent needed another therapy for their hemorrhoids. Only 36 percent (32/88 patients with follow-up of 12 months or more) stated that the operation (still) had a positive effect on their symptoms. Of course, we tried to find out why the results were so disappointing in the long-term compared with those published:
2.
3.
Aigner et al.6 published on the anatomic variations of the hemorrhoidal arteries and showed arteries that supply the hemorrhoidal cushions on a distal level where they cannot be ligated by HAL.
4.
According to the figure, the HAL device used by Felice et al. has an outer diameter of 25 mm: the dilatating effect of inserting this device into the anal canal (for 18 minutes) might have reduced the resting pressure and improved the venous outflow of the hemorrhoidal cushions.
5.
Anatomic studies have shown that hemorrhoids are arteriovenous cushions: by ligating the main vessels the smaller hemorrhoidal vessels will hypertrophy in time and symptoms could recur.
6.
Jensen et al.7 published an article about the natural course of hemorrhoids and found a natural healing rate of 39 percent after four years.