[What are piles?]
[ITV This Morning Article]
Commonly referred to as piles, over half the population will suffer from haemorrhoids at some stage and tens of thousands will undergo painful surgery. Piles are incredibly common - at least 50 per cent of people suffer with them at some time.
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[Doppler-guided transanal haemorrhoidal dearterialisation]
[Article in Italian]
Tagariello C, Dal Monte PP, Sarago M.
UO Chirurgia Generale, Case di Cura M. F. Toniolo, Villa Erbosa, Bologna.
The usual surgical treatment for haemorrhoids consists in excision of the piles and ligation of the hemorrhoidal plexus, with considerable postoperative pain. A new, less invasive technique has been introduced, called transanal haemorrhoidal dearterialisation. This technique consists in Doppler-guided ligation of the distal branches of the superior rectal arteries (3 to 6) 2-3 cm above the pectinate line. Arterial ligation causes reduction of blood flow to, and decongestion of, the haemorrhoidal plexus. From January 2000 to September 2003, we performed transanal haemorrhoidal dearterialisation in 138 patients. Patients experienced no pain in the immediate postoperative period. The follow-up revealed good outcomes. The transanal haemorrhoidal dearterialisation procedure can be considered a safe, effective, painless and quick method of curing haemorrhoidal disease. Its indications are extensive. The success rate is approximately 90%, but may be lower for grade 4 haemorrhoids.
PMID: 15553442 [PubMed - in process]
[New modalities and concepts in the treatment of hemorrhoids]
[Article in German]
Hetzer FH, Wildi S, Demartines N.
Klinik fur Viszeral- und Transplantationschirurgie, Universitatsspital Zurich.
The surgical treatment of haemorrhoids has significantly changed by introducing new techniques in the last years. Nowadays, low grade haemorrhoids, grade II and III, are easily and painfree treatable by a minimal invasive, Doppler transducer guided ligation of the haemorrhoidal arteries. In cases of circular protruding haemorrhoids, grade III and IV; the stapled mucosectomy described by Longo is also a new effective treatment. Both procedures can be performed for an outpatient or with short hospital stay and allows patients to return to work earlier compared to conventional techniques. Additionally, due to the new techniques the treatment of haemorrhoids is less painful and has increased patients' satisfaction. Therefore, the traditional haemorrhoidectomy, the Milligan-Morgan or the Ferguson procedure, has become less common and is only performed in a few special indications.
Publication Types:
• Review
• Review, Tutorial
PMID: 14535037 [PubMed - indexed for MEDLINE]
[Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study]
Bursics A, Morvay K, Kupcsulik P, Flautner L.
First Department of Surgery, Semmelweis University, 1082 Budapest, Hungary. bu@seb1.sote.hu
BACKGROUND AND AIMS: Doppler-guided hemorrhoid artery ligation is a new approach for treating hemorrhoids. Early and 1-year follow-up results of the procedure are presented and compared with those of closed scissors hemorrhoidectomy in a prospective randomized study. PATIENTS AND METHODS: Sixty consecutively recruited patients were randomized into two groups: group A ( n=30) was treated with standardized closed scissors hemorrhoidectomy and group B ( n=30) with Doppler-guided hemorrhoid artery ligation. The follow-up period was 11.7+/-4.6 months. RESULTS: The average need for minor analgesics was 11.7+/-12.6 doses in group A and 2.9+/-7.7 in group B. Patients in group A spent 62.9+/-29.0 hours in hospital postoperatively and those in group B 19.8+/-41.8 hours. Return to normal daily activities took 24.9+/-24.5 days in group A and 3.0+/-5.5 days in group B. Neither the disappearance (26 vs. 25 patients) nor the recurrence of preoperative symptoms (5 vs. 6 patients) differed significantly between the two groups. CONCLUSION: Both procedures were effective in treating hemorrhoids. The 1-year results of Doppler-guided hemorrhoid artery ligation do not differ from those of closed scissors hemorrhoidectomy. Doppler-guided hemorrhoid artery ligation seems to be ideal for 1-day surgery, and it fulfills the requirements of minimally invasive surgery.
Publication Types:
• Clinical Trial
• Randomized Controlled Trial
PMID: 12845454 [PubMed - indexed for MEDLINE]
[Results of ligature of distal branches of the upper rectal artery in chronic hemorrhoid with the assistance of Doppler ultrasonography]
[Article in Russian]
Shelygin IuA, Titov AIu, Veselov VV, Kanametov MKh.
In October 2000 to February 2002 Doppler ultrasonography assisted suturing and ligation of hemorrhoidal arteries were performed in 102 patients with chronic hemorrhoids (57 men, 45 women, mean age 44 +/- 4.3 years). The mean duration of the disease was 10 +/- 4.6 years. Elimination of scarlet blood and hemorrhoidal prolapse without concomitant proctologic diseases were indications for surgery. Sixty-nine patients were followed up for more than 12 months, the follow-up lasted on the average 12 +/- 4 months. There were no clinical symptoms in 57 (82.6%) on the 69 patients. Combined ligation of arterial branches and nodes with latex rings was performed in 7 patients with stages III-IV hemorrhoids. Sclerotherapy was performed in 2 patients with stage III with occasional elimination of blood on defecation. Hemorrhoidectomy was performed in 3 (2.9%) patients with stage IV hemorrhoid due to ineffective ligation. Suturing and ligation of distal branches of the upper rectal artery decrease the inflow of arterial blood to hemorrhoidal nodes without venous outflow disorders. Fixation of hemorrhoidal nodes to the muscular wall eliminates the symptoms of hemorrhoidal prolapse. These factors lead to elimination of hemorrhoidal symptoms in 82.6% of the patients operated on.
PMID: 12645208 [PubMed - indexed for MEDLINE]
[Doppler ultrasound assisted hemorrhoid artery ligation. A new therapy in symptomatic hemorrhoids]
[Article in German]
Arnold S, Antonietti E, Rollinger G, Scheyer M.
Chirurgische Abteilung, Krankenhaus der Stadt Bludenz, Spitalsgasse 13, 6700 Bludenz, Osterreich. docarno@aon.at
In 1995, Morinaga et al. (Japan) reported on a new technique in the treatment of hemorrhoids. We report the results of our first 105 patients thus treated. By a specially designed proctoscope coupled with a Doppler transducer, the hemorrhoidal arteries are looked for and ligated. All stages of hemorrhoid were treated. This method is painless, successful, and has a low rate of complications. It is for outpatients and is an alternative to all other methods in the treatment of hemorrhoids.
PMID: 11963502 [PubMed - indexed for MEDLINE]
[Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy]
Sohn N, Aronoff JS, Cohen FS, Weinstein MA.
Department of Surgery, Lenox Hill Hospital, New York, NY, USA. nsohn@ssamed.com
BACKGROUND: Transanal hemorrhoidal dearterialization (THD), a new approach for patients who would otherwise require an operative hemorrhoidectomy, accomplishes hemorrhoidal symptom relief with far less postoperative pain than an operative hemorrhoidectomy. METHODS: THD, an ambulatory procedure, employs a specially designed proctoscope coupled with a Doppler transducer to allow identification and suture ligation of the hemorrhoidal arteries. RESULTS: Sixty patients between ages 22 and 87 were treated. Bleeding was fully corrected in 88%, protrusion in 92%, and pain in 71%. Two patients (3%) failed to improve with THD. Complications included pain resulting in greater than 2 days loss of work in 5 patients, postoperative perirectal thromboses developed in 4 patients, and an anal fissure developed in 1 patient. CONCLUSIONS: THD was an effective alternative to operative hemorrhoidectomy. It may be the only option for patients where an operative hemorrhoidectomy is contraindicated because of incontinence.
PMID: 11754861 [PubMed - indexed for MEDLINE]
[Ambulatory haemorrhoid therapy]
[Article in German]
Muller-Lobeck H.
Abteilung Chirurgie/Koloproktologie, Stiftung Deutsche Klinik fur Diagnostik GmbH, Wiesbaden.
For thousands of years, anal complaints were treated symptomatically with ointments, suppositories and, in isolated cases, even surgically. Since the middle of the last century injection sclerotherapy has been by far the most widespread out-patient treatment for the very common haemorrhoidal disease. This is based on the notion that haemorrhoids are varicosities, and while this idea has been contested by the theory of a spongy body for over 200 years, it is nonetheless only in the last 40 years that the spongy body theory has become accepted, giving rise to further important functional investigations on the anal structures involved in bowel continence and to rational treatment for haemorrhoids. The conditions necessary for out-patient treatment of haemorrhoids and the options available are presented in this paper and discussed with reference to acceptance, inherent risks, and the possible complications. While diet and behavioural methods, and also anal dilatation and treatment with ointments, can be managed by the patient without any problems, regardless of how effective sclerotherapy and rubber band ligation are, these involve risks whose ramifications are often underestimated. One operative procedure that may well become established as an effective out-patient method in the future is Doppler-guided isolated haemorrhoidal artery ligation (HAL) after Morinaga. Traditionally, day surgery is not so well accepted for haemorrhoidectomy in Germany; unless the operation planned is not very extensive, in-patient treatment is still considered preferable.
Publication Types:
• Review
• Review, Tutorial
PMID: 11469087 [PubMed - indexed for MEDLINE]
[Medical Reports on HAL (in chronologic order)]
Morinaga K., et al,
A novel therapy for internal hemorrhoids: liagtion of the hemorrhoidal artery in conjunction with a Doppler flowmeter. Am. J. GE, Vol.90. No.4. 1995.
Sohn N, Aronoff J, Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182; 5: 132-37.
Arnold S., Antonietti E., Rollinger G., Scheyer M., Surgical Department Hospital of Bludenz / Austria.
Doppler guided hemorrhoid artery ligation. A new treatment of hemorrhoids? “Der Chirurg”, 2002. 73:269 – 273, Springer Verlag 2002.
Summary: 105 Patients. All stages of hemorrhoids were treated by this method. The HAL method is painless, successful and has a low rate of complications. It is four outpatients and it is an alternative to all other methods in the treatment of hemorrhoids.
[Original article in German]
Beck J., Ebner St., Mueller W., Beller S., Szinicz G., Surgical Department Hospital Bregenz / Austria.
Report on 184 patients all grade II hemorrhoids, treated between 2000 and 2002, No intra- or peri-operative complications, patient satisfaction was measured 1 week, 1 month and 6 month after the procedure.
[Original article in German]
Gallese N.
Hemorrhoidal Artery Ligation (H.A.L.) using Ultrasound Blood Flow Detector HAL-Doppler: an innovation in proctology.
Department of General Surgery, UCP Coloporoctology Unit, San Gavino Monreale Hospital (CA) ]- Italy, 2002.
Report on 150 patients, follow up period more then 12 month
Results: When properly used, H.A.L. is highly effective, with 98% positive responses, even if further experimentation and verification are necessary.
Conclusion: the H.A.L. Technique involves simple artery ligations on the level of rectal mucosa without excisions or tissue necrosis; the method is painless and can be done on an out-patient basis with immediate return to work.
[Original article in Italian]
Coyoli García Oscar, Cruz Santiago César A.
Ligadura Doppler en el tratamiento de la enfermedad hemorroidal.
Toledo CRC, Herrejón CJM, Stahl DEM, González S, Martínez HA, Sepúlveda CRR, Servicio de Coloproctología Hospital Regional ALM ISSSTE / Mexico / Year 2003
A prelimianry report about their first 25 patients. Excellent results, follow up period 4 month only, the prelimanry result and impression encourages the team to further evaluate the HAL procedure.
[Original article in Spanish]
S. Wildi, Hetzer F., Demartines N., Clavien P.A., University Hospital Zurich / Switzerland.
Doppler Guided Hemorrhoidal Artery Ligation (HAL): a new, valuable alternative in the treatment of the hemorrhoidal disease.
Summary: The HAL method stays for an efficient and a nearly pain-free treatment of stage II and stage III hemorrhoids.
[Original article in German. 2003]
Gold D., MSc. FRCS (Eng), FRCS (GenSurg), MBBS, Consultant Colorectal Surgeon, The North Hampshire Hospital, UK.
Preliminary report on his first 15 patients, with severe grade 2/3 hemorrhoids. No complication such as hemorrhage or retention of urine. All patients were discharged the same day. Follow up 3 month. In 13 out of 15 patients have avoided formal hemorrhoidectomy.
Conclusion so far: it is not a final solution to hemorrhoids but has certainly become my procedure of choice for all patients requiring formal hemorrhoidectomy, where the main complaint is either bleeding or prolapse.
A. Bursics, K. Morvay, P. Kupcsulik, L. Flautner, First Department of Surgery, Semmelweis University, 1082 Budapest, Hungary.
Title: Comparison of early and 1-year follow-up results of conventional hemmorrhoidectomy and hemorrhoid artery ligation: a randomized study.
Issued in the "International Journal of Colorectal Disease", accepted May 2003
Zagrjadsky Eugeny Alekseevich, Chief of the department colorectal surgery of the medical center, Moscow, Russia
Title: doppler guided hemorroidal artery ligation (HAL) for the treatment of hemorrides- result in 169 patiens.
Orginal report in Englisch, October 2003 and September 2004
Download: Medical Report
J. L. Narro, Doctor for Surgery, Germany, Cologne
Title: Hemorrhoid Therapy with Doppier Guided Hemorrhoidal Artery Ligation via Proctoscope KM-25. A New Alternative to Hemorrhoidectomy and Rubber Band Ligation?
Issue: Zentralbl Chir 2004
[Original article in German, 2004]
A. Hardy, C.L.H. Chan, C.R.G. Cohen
The surgical Management of Haemorrhoids - A Review
A number of new surgical treatments have led to a reappraisal of haemorrhoid disease over the last few decades. Despite a range of treatment modalities, the options are limited in thier effectiveness and can lead to a number of complications. An inadequate classification system based on appearance rather than symptoms makes the choice of appropirate therapy difficult. More recent techniques have led to a move away from surgical excision. However, furthre research is required to establish their precise indications and long-term efficacy.
Digestive Surgery, 2005
St. Mark's Hospital, Harrow UK
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