Background: There are broad ranges of interventions described for treatment of haemorrhoidal disease. Each method has advantage, disadvantage and method specific complications. Doppler guided haemorrhoidal artery ligation with or without added mucopexy is a relatively newer technique for treating haemorrhoidal disease. Our aim is to study the effectiveness, post operative complications and outcome of this newer treatment option in 100 consecutive cases for period of 1 year follow up.

Materials and Methods: This prospective clinical study carried out in 100 consecutive patients admitted with grade 3 and grade 4 symptomatic haemorrhoidal diseases. The patients were evaluated preoperatively and postoperatively for improvement of symptoms, complications and recurrence of the symptoms. Follow up period was 1 year.

Results: In our study of 100 cases, mean age of the patients was 48.3years. 62% of them presented to us with bleeding per rectum as their major presenting complaint followed by 20% with mucosal prolapse .Average duration of surgery was 43minutes and 85% of patients discharged after 24 hours of observation in hospital Immediate complications like intra operative and early post operative bleeding, urinary retention had seen in 13% and 10% patients which were managed conservatively. 12% patients had sustained pain at the end of 1 week but 1 month, 6month and 1year follow up there was no pain. No major complications occurred during the study. However 12% patients complained of recurrence of symptoms at the end of 1 year follow up.

Conclusion: Doppler guided haemorrhoidal artery ligation with or without additional mucopexy provides a low morbidity minimally invasive option for treatment of haemorrhoidal disease with adequate safety and efficacy and acceptable complication rates.

Keywords: Doppler, Mucopexy, Artery ligation.

1. Sun, Zhifei, and John Migaly. “Review of Hemorrhoid Disease: Presentation and Management.” Clinics in colon and rectal surgery 29,1 (2016): 22-9. doi:10.1055/s-0035-1568144.
2. Jayaraman S,  Colquhoun  PH,  Malthaner    Stapled versus conventional surgery for hemorrhoids.  Cochrane Database Syst Rev 2006;(4):CD00539.
3. Chen JS, You JF. Current status os surgical treatment for hemorrhoids: systemic review and meta-analysis. Chang Gung Med J 2010;33:488-500.
4. Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol. 1995;90:610–3.
5. Thomson WH. The nature and cause of haemorrhoids. Proc R Soc Med. 1975; 68:574–575.
6. Simillis C, Thouukididou SN, Slesser AA, Rasheed S, Tan E, et al. Systemic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatment for haemorrhoids. Br J Surg,2015;102(13):1603-1608.
7. Infantino A, Altomare DF, Bottini C, et al. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis. 2012;14:205–211.
8. Ratto c, Donisi L, Parello A, Litta F, Zaccone G, De Simone V. Distal Doppler-guided deartererialization is highly effective in treating haemorrhoids by transanal haemorrhoidal deartererialization. Colorectal Dis. 2012;14:786-9
9. Denoya P, Tam J, Bergamaschi R. Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial. Tech Coloproctol. 2014; 18:1081–1085
10. Stefan Morarasu*,1, Emmanuel Eguare2, Yasir Bashir2, Qurat ul Ain2, Anca Bradul 1“Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania, 2Allen Ward, Naas General Hospital, Naas, Co. Kildare, Ireland Transanal Haemorrhoid Dearterialisation and mucopexy: a minimal invasive approach for prolapsed haemorrhoids. Four cases report
11. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y.Doppler-Guided Hemorrhoidal Artery Ligation for the Treatment of Symptomatic Hemorrhoids: Early and Three-Year Follow-up Results in 100 Consecutive Patients. Dis Colon Rectum 2011; 54: 226-231
12. Ratto C, Donisi L, Parello A, Litta F, Doglietto GB. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum. 2010;53:803–81
13. Dal Monte PP, Tagariello C, Sarago M, Giordano P, Shafi A, Cudazzo E, Franzini M. Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol. 2007;11:333–338; discussion 338-339

Dr Pradeep Kumar J

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