336 CONSECUTIVE DOPPLER GUIDED HEMORRHOIDAL ARTERY LIGATIONS (DGHAL)

Abstract

Objectives: Our purpose is to expose a new surgical technique for the treatment of II-III degrees haemorrhoids with pain-less and complication free post-operative period, with a considerable improvement of clinic story and with a very short time for return to work or to normal daily activity. Materials and Methods: From March 2004 to March 2009 we performed 336 consecutive DGHAL in patients (128 male and 208 female) with II (227 pts)-III (109 pts) grade hemorroidal disease in local anesthesia. The DGHAL procedure is performed with a special proctoscope (HAL Doppler , Pharma EECTM) that with an US probe can explore, above the dentate line, the arterial flux of median rectal artery. Across the proctoscope and with a special needle it’s possible to suture precisely the artery found with the US. This procedure was performed, always above the dentate line, at level of the haemorrhoidal peduncles with the patients in gynaecological position. Results: One or 2 hours after the surgery all the patients didn’t feel any symptoms because of the absence of anal wounds. The first evacuation didn’t give any pain; in 97 patients a light discomfort like an intra-anal weight persisted for 24-48 hours. The discharge was possible in the evening (253 pts) or almost at next morning (83 pts). No stenosis or incontinence problems occurred after the operation. In 4 patients haematoma was encountered in perioperative period. Conclusion: The DGHAL represents an ideal management for 1-day surgery, and it fulfills the requirements of minimally invasive surgery in patients with II-III degree hemorrhoids. The best advantage is the quite absence of complications and the evidence of significantly improvement of clinic story. From the short-term effect view, we think that DGHAL can be adopted in symptomatic hemorrhoids, which is a safe and easy procedure with good results that requires a very short-time training.