Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrhoidal artery ligation: functional results after 1-year follow-up



Doppler-guided hemorrhoidal artery ligation (DGHAL), as a method of treating hemorrhoidal disease, is currently used in many centers across Europe, Asia, and Australia. The aim of our study was to evaluate the clinical effectiveness and functional results of DGHAL as estimated by means of anorectal manometry.

Materials and methods

Between 2000 and 2006 the DGHAL procedure was performed on 507 patients with II–IV degree hemorrhoids in two centers (Poland and Austria). Three hundred eight patients were included in the initial phase of the study, designed to estimate the method’s effectiveness. During the second phase (199 patients) selected functional results were also assessed. Patients were classified as having grade II (144), III (319), and IV (44) hemorrhoids.


There were no intra- and immediate postoperative complications. Good results were reported by 351 patients (69.2%), and were acceptable in a further 75 cases (4.8%). When the patients were grouped according to the stage of hemorrhoidal disease, 133 out of 144 patients (92.4%) with grade II and 272 out of 324 (84%) with grade III had very good or good results. Only 18 out of 44 patients (41%) with grade IV were satisfied with the operation. Fifty-nine patients after anorectal folds, fissure or anal canal polyp excision required analgesics for 1–2 days. Apart from lower contraction amplitude and contraction speed after 1 month there were no differences in anorectal functional tests.


Based on our results we may conclude that DGHAL is a safe and effective method and may offer an important alternative to operative hemorrhoidectomy with no risk of postoperative stool incontinence, minimal postoperative pain, and early return of patients to their normal activities. Nevertheless, this is a fairly new procedure with a short-term follow-up. Until 5-year observations of large, multicenter, randomized trials are published we cannot recommend this method as a gold-standard procedure, although it still can offer significant benefits to patients.

This is a preview of subscription content, log in to check access.


  1. 1.

    Thomson WHF (1975) The nature of hemorrhoids. Br J Surg 62:542–552

  2. 2.

    Parks AG (1956) The surgical treatment of hemorrhoids. Br J Surg 43:337–351

  3. 3.

    Ferguson JA, Heaton JR (1959) Closed hemorrhoidectomy. Dis Colon Rectum 2:176–179

  4. 4.

    Ho YH, Cheong WK, Tsang C et al (2000) Stapled hemorrhoidectomy–cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 43:1666–1675

  5. 5.

    Gupta PJ (2002) Novel technique: radiofrequency coagulation–a treatment for early-stage hemorrhoids. Med Gen Med 4:1

  6. 6.

    Ganio E, Altomare DF, Gabrielli F et al (2001) Prospective randomized multicentre trial comparing stapled with open hemorrhoidectomy. Br J Surg 88:669–674

  7. 7.

    Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled hemorrhoidopexy versus conventional hemorrhoidectomy. Br J Surg 89:1376–1381

  8. 8.

    Pernice LM, Bartalucci B, Bencini L et al (2001) Early and late (ten years) experience with circular stapler hemorrhoidectomy. Dis Colon Rectum 44:836–841

  9. 9.

    Shalaby R, Deskoy A (2001) Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 88:1049–1053

  10. 10.

    Barron J (1963) Office ligation of internal hemorrhoids. Am J Surg 105:563–567

  11. 11.

    Blaisdell PC (1958) Office ligation of internal hemorrhoids. Am J Surg 96:401–404

  12. 12.

    Farag AE (1978) Pile suture: a new technique for the treatment of hemorrhoids. Br J Surg 65:293–295

  13. 13.

    Awojobi OA (1983) Modified pile suture in outpatient treatment of hemorrhoids. A preliminary report. Dis Colon Rectum 26:95–97

  14. 14.

    Morinaga K, Hasuda K, Ikeda T (1995) 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 90:610–613

  15. 15.

    Armstrong DN (2003) Multiple hemorrhoidal ligation: a prospective, randomized trial evaluating a new technique. Dis Colon Rectum 46:179–186

  16. 16.

    Arnold S, Antonietti E, Rollinger G et al (2002) Doppler-guided hemorrhoid artery ligation–a new treatment of hemorrhoids. Chirurg 73:269–273

  17. 17.

    Sohn N, Aronoff JS, Cohen FS et al (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182:515–519

  18. 18.

    Meintjes D. Doppler-guided hemorrhoidal artery ligation (HAL) for the treatment of hemorrhoids. Results in 1415 patients. Available at http://www.cjmedical.com/haemorrhoids. Accessed 10 February 2007

  19. 19.

    O’Hara VS (1980) Fatal clostridial infection following hemorrrhoidal banding. Dis Colon Rectum 23:570–571

  20. 20.

    Russel TR (1985) Donohue JH (1985) Hemorrhoidal banding. A warning. Dis Colon Rectum 28:291–293

  21. 21.

    Hulme-Moir M, Bartolo DC (2001) Hemorrhoids. Gastroenterol Ciln North Am 30:183–197

  22. 22.

    Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidectomy. Br J Surg 89(11):1376–1381

  23. 23.

    Herman RM, Richter P, Wałęga P et al (2001) Anorectal sphincter function and rectal barostat study in patients following trananal endoscopic microsurgery. Int J Colorectal Dis 16:370–376

Download references

Author information

Correspondence to Jakub Kenig.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Wałęga, P., Scheyer, M., Kenig, J. et al. Two-center experience in the treatment of hemorrhoidal disease using Doppler-guided hemorrhoidal artery ligation: functional results after 1-year follow-up. Surg Endosc 22, 2379 (2008). https://doi.org/10.1007/s00464-008-0030-x

Download citation


  • Doppler-guided hemorrhoidal artery ligation
  • Hemorrhoidal disease