Hemorrhoidal Artery Ligation for Patients with Bleeding Tendencies: Peri-operative Outcomes

Authors

  • Eakarach Lewthanamongkol Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital
  • Jirawat Pattana-arun Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital
  • Shankar Gunarasa Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital
  • Supakij Khomvilai Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital

Keywords:

Massive bleeding hemorrhoid, Bleeding tendencies, Doppler-guided hemorrhoidal artery ligation

Abstract

Background: Bleeding hemorrhoids in patients with bleeding tendencies may be very harmful and fatal. Hemorrhoidectomy may cause further bleeding from surgical wound. In this situation, Doppler-guided hemorrhoidal artery ligation (DGHAL) seems a better choice, because this technique occludes the feeding arteries or hemorrhoids under Doppler guidance without any surgical wound. We examined the effectiveness of DGHAL to control bleeding in this group of patients.

Methods: Patients diagnosed with Hemorrhoids with bleeding tendencies who were treated with DGHAL during January 2008 to December 2014 were included in this study. The peri-operative outcomes were reviewed.

Results: From the data records, we obtained 11 patients who had bleeding tendencies undergoing DGHAL for hemorrhoids. At one month post DGHAL, only one patient had occasional spotting which spontaneously resolved without any intervention.

Conclusions: DGHAL is an effective alternative treatment for bleeding hemorrhoid. Without tissue resection and under Doppler guidance, it is of benefit for bleeding hemorrhoids in patients with bleeding tendencies.

 

References

1. Ozdil B, Akkiz H, Sandikci M, et al. Massive lower gastrointestinal hemorrhage secondary to rectal hemorrhoids in elderly patients receiving anticoagulant therapy: case series. Dig Dis Sci 2010;55:2693-4.

2. 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.

3. Aigner F, Bodner G, Conrad F, et al. The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 2004;187:102-8.

4. Aigner F, Bodner G, Gruber H, et al. The vascular nature of hemorrhoids. J Gastrointest Surg 2006;10:1044-50.

5. Schuurman JP, Go PM, Bleys RL. Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 2009;11:967-71.

6. Ratto C, Parello A, Donisi L, et al. Assessment of haemorrhoidal artery network using colour duplex imaging and clinical implications. Br J Surg 2012;99:112-8.

7. Giamundo P, Cecchetti W, Esercizio L, et al. Doppler-guided hemorrhoidal laser procedure for the treatment of symptomatic hemorrhoids: experimental background and short-term clinical results of a new mini-invasive treatment. Surg Endosc 2011;25:1369-75.

8. Ratto C, Donisi L, Parello A, et al. çDistal Doppler-guided dearterializationé is highly effective in treating haemorrhoids by transanalhaemorrhoidaldearterialization. Colorectal Dis 2012;14:e786-9.

9. Sammartano A, Palumbo VD, Damiano G, et al.Colour Doppler-guided haemorrhoidal artery ligation: an adjunct in identification of haemorrhoidal vessels. Tech Coloproctol 2013;17:469-71.

10. Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol 2014;18:291-8.

11. Sohn N, Aronoff JS, Cohen FS, et al. Transanalhemorrhoidaldearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 2001;182:515-9.

12. Wallis de Vries BM, van der Beek ES, de Wijkerslooth LR, et al. Treatment of grade 2 and 3 hemorrhoids with Dopplerguided hemorrhoidal artery ligation. Dig Surg 2007;24:436-40.

13. Faucheron JL, 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 2008;51:945-9.

14. Walega P, Scheyer M, Kenig J, et al. Two-center experience in the treatment of hemorrhoidal disease using Dopplerguided hemorrhoidal artery ligation: functional results after 1-year follow-up. Surg Endosc 2008;22:2379-83.

15. Faucheron JL, Poncet G, Voirin D, et al. Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HALRAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum 2011; 54:226-31.

16. JeongWJ, Cho SW, Noh KT, et al. One Year Follow-up Result of Doppler-guided Hemorrhoidal Artery Ligation and Recto-Anal Repair in 97 Consecutive Patients. J Korean Soc Coloproctol 2011;27:298-302.

17. Ratto C, Giordano P, Donisi L, et al. Transanalhaemorrhoidaldearterialization (THD) for selected fourth-degree haemorrhoids. Tech Coloproctol 2011;15:191-7.

18. Spyridakis M, Christodoulidis G, Symeonidis D, et al. Outcomes of Doppler-guided hemorrhoid artery ligation: analysis of 90 consecutive patients. Tech Coloproctol 2011;15 Suppl 1:S21-4.

19. Szmulowicz UM, Gurland B, Garofalo T, et al. Doppler-guided hemorrhoidal artery ligation: the experience of a single institution. J Gastrointest Surg 2011;15:803-8.

20. Avital S, Inbar R, Karin E, et al. Five-year follow-up of Dopplerguided hemorrhoidal artery ligation. Tech Coloproctol 2011; 16:61-5.

21. Ratto C, Parello A, Veronese E, et al. Doppler-guided transanalhaemorrhoidaldearterialization for haemorrhoids: results from a multicentre trial. Colorectal Dis 2015;17:O10-19.

22. Scheyer M, Antonietti E, Rollinger G, et al.Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center. Tech Coloproctol 2015;19:5-9.

23. Cavazzoni E, Bugiantella W, Graziosi L, et al. Emergency transanalhaemorrhoidal Doppler guided dearterialization for acute and persistent haemorrhoidal bleeding. Colorectal Dis 2013;15:e89-92.
vol38no3

Downloads

Published

2017-09-28

How to Cite

1.
Lewthanamongkol E, Pattana-arun J, Gunarasa S, Khomvilai S. Hemorrhoidal Artery Ligation for Patients with Bleeding Tendencies: Peri-operative Outcomes. Thai J Surg [Internet]. 2017 Sep. 28 [cited 2024 Nov. 6];38(3):99-103. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/219966

Issue

Vol. 38 No. 3 (2017): July – September

Section

Original Articles

License

Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.