World J Surg Surg Res | Volume 2, Issue 1 | Surgical Technique | Open Access

Doppler Guided Hemorrhoidal Artery Ligation - A Minimally Invasive Treatment for Symptomatic Hemorrhoids

Samuel Stefan1, Ashutosh Gumber1, Syed Naqvi1 and Jim Khan1,2*

1Department of Colorectal Surgery, Portsmouth Hospital, UK
2Anglia Ruskin University, Cambridge, UK

*Correspondance to: Jim S Khan 

Fulltext PDF


Background: Hemorrhoids remain one of the commonest conditions affecting humans. Excisional
hemorrhoidectomy is classified as the best treatment for this pathology, with lower postoperative
recurrence rates; however it is associated with significant morbidity. This study aims to evaluate
the outcomes of Doppler guided hemorrhoidal artery ligation for the symptomatic grade III/IV
Methods: Over a period of 7 years (2010-2016) all patients having a Transanal Hemorrhoidal Artery
Dearterialisation (THD) procedure by a single surgeon were included in this single centre cohort
study. Patient demographics, operative outcomes and long-term results were recorded. Assessments
were carried out at 3 weeks, 2 months, then at 2 years periods for symptom evaluation.
Results: 136 patients underwent THD procedure at this centre. 58% were men with a median BMI
of 26. Rectal bleeding was the commonest presenting complaint. Over 75% patients received officebased
procedures prior to THD. THD was successfully carried out in all patients.
Majority of procedures were performed as day case and 13% patients required an overnight stay.
There were no complications in 73% of patients. Reported postoperative complications included
constipation, urinary retention, anal fissure, skin tags, bleeding and perianal hematoma (Figure 3).
Sustained symptomatic improvement was seen across four domains (bleeding, pain, itching and
soiling) at 2 months and 2 years (Figure 4).
Conclusion: THD remains an effective and successful treatment option for the management of
symptomatic hemorrhoids. Faster post-operative recovery and acceptable long-term results make
this an attractive option for patients with medium to large hemorrhoids.



Stefan S, Gumber A, Naqvi S, Khan J. Doppler Guided Hemorrhoidal Artery Ligation - A Minimally Invasive Treatment for Symptomatic Hemorrhoids. World J Surg Surgical Res. 2019; 2: 1174..

Subscribe to Our Newsletter