Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery in patients who fail rubber band ligation treatment.

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.