The Author Replies

Excerpt

To the Editor—I was pleased to know that Drs. Jongen and Peleikis enjoyed our article, although Idisagree with their advice to abandon the hemorrhoidal artery ligation (HAL) technique. The follow-up of our patients had a mean of 11 months, and positive results were obtained in >90 percent of cases. Ligation of all arteries in the same session is a prerequisite for the successful outcome of the procedure. In their letter, Drs. Jongen and Peleikis did not mention the details of the technique that they used. How many arteries were ligated in the 25 percent of patients who showed recurrence of hemorrhoids? How many of these patients had a second attempt at the HAL procedure? When recurrences occur, these are usually of minor degree and the procedure can be easily repeated. It usually requires a shorter operation time, with only one to two arteries needing ligation. The short learning curve of the procedure, the absence of major complications that are seen with other techniques (e.g., stapled hemorrhoidectomy), and the high effectiveness after a single procedure (contrary to rubber band ligation) makes it the first choice for thetreatment of Grade III hemorrhoids. However, Iagree that further studies on larger numbers are needed to definitely establish its role. …