Indian Journal of Surgery

, Volume 81, Issue 4, pp 332–337 | Cite as

Clinical Outcome after Doppler-Guided Hemorrhoidal Artery Ligation and Rubber Band Ligation for Treatment of Primary Symptomatic Hemorrhoids

  • Adel M. Shehata
  • Abdel Fattah Saleh
  • Amr Abd El-Hameed El-HeenyEmail author
Original Article


To compare the efficacy and clinical outcome after rubber band ligation (RBL) and Doppler-guided hemorrhoidal artery ligation (DG-HAL) for primary symptomatic (grades II and III) hemorrhoids. Fifty patients with symptomatic grades II and III uncomplicated internal hemorrhoids were randomly assigned to treatment with RBL or DG-HAL. Patients were assessed clinically for postoperative complications and recurrence through 6 months after surgery. Preoperative characteristics were similar between both groups. The main preoperative complaint was protrusion of piles followed by bleeding. The overall rate of complications was 16% after RBL (9.1% of grade II and 21.4% of grade III) and 4% after DG-HAL (6.7% of grade II and 0% of grade III). The overall rate of recurrence was 12% after RBL (9.1% of grade II and 14.3% of grade III) and 4% after DG-HAL (0% of grade II and 10% of grade III). All complications were conservatively controlled with no need for reintervention. At the end of 6 months of follow-up, the overall freedom of symptoms was 88% after RBL (90.9% of grade II and 85.7% of grade III) and 96% after DG-HAL (100% of grade II and 90% of grade III). With respect to grade of hemorrhoids (II or III), there were statistically insignificant differences between both procedures in terms of recurrence and complications. DG-HAL is safer and effective than RBL for treatment of grade III hemorrhoids, however in grade II patients, both procedures had nearly equal rate of complications despite no recurrence with DG-HAL.


Hemorrhoids Doppler Rubber Ligation 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Singer M (2011) Hemorrhoids. In: Beck DE, Robert PL, Saclarides TJ et al (eds) The ASCRS textbook of colon and rectal surgery, 2nd edn. Springer, New York, pp 175–202CrossRefGoogle Scholar
  2. 2.
    Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck S, Stift A (2012) The prevalence of hemorrhoids in adults. Int J Color Dis 27:215–220CrossRefGoogle Scholar
  3. 3.
    Ganz RA (2013) The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol 11:593–603CrossRefGoogle Scholar
  4. 4.
    El Nakeeb AM, Fikry AA, Omar WH, Fouda EM, El Metwally TA, Ghazy HE et al (2008) Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol 14(42):6525–6530CrossRefGoogle Scholar
  5. 5.
    Longman RJ, Thomson WH (2006) A prospective study of outcome from rubber band ligation of piles. Color Dis 8:145–148CrossRefGoogle Scholar
  6. 6.
    Khan AN, Khan NA (2010) A prospective study of outcome from rubber band ligation in third degree haemorrhoids. J Pak Med Assoc 60(11):952–955Google Scholar
  7. 7.
    Yilmaz İ, Sücüllü İ, Karakaş DÖ, Özdemir Y, Yücel E, Akin ML (2012) Doppler-guided hemorrhoidal artery ligation: experience with 2 years follow-up. Am Surg 78(3):344–348Google Scholar
  8. 8.
    Lohsiriwat V (2013) Approach to hemorrhoids. Curr Gastroenterol Rep 15(7):332CrossRefGoogle Scholar
  9. 9.
    Kaidar-Person O, Person B, Wexner SD (2007) Hemorrhoidal disease: a comprehensive review. J Am Coll Surg 204:102–117CrossRefGoogle Scholar
  10. 10.
    Forlini A, Manzelli A, Quaresima S, Forlini M (2009) Long-term result after rubber band ligation for haemorrhoids. Int J Color Dis 24:1007–1010CrossRefGoogle Scholar
  11. 11.
    Mounsey AL, Halladay J, Sadiq TS (2011) Hemorrhoids. Am Fam Physician 84(2):204–210Google Scholar
  12. 12.
    Gagloo MA, Hijaz SW, Nasir SA, Reyaz A, Bakshi IH, Chowdary NA, Naqash SA, Sharief BM (2013) Comparative study of hemorrhoidectomy and rubber band ligation in treatment of second and third degree hemorrhoids in Kashmir. Indian J Surg 75(5):356–360CrossRefGoogle Scholar
  13. 13.
    Misauno MA, Usman BD, Nnadozie UU, Obiano SK (2013) Experience with rubber band ligation of hemorrhoids in northern Nigeria. Niger Med J 54(4):258–260CrossRefGoogle Scholar
  14. 14.
    Azizi R, Rabani-Karizi B, Taghipour MA (2010) Comparison between Ultroid and rubber band ligation in treatment of internal hemorrhoids. Acta Med Iran 48(6):389–393Google Scholar
  15. 15.
    Watson NF, Liptrott S, Maxwell-Armstrong CA (2006) A prospective audit of early pain and patient satisfaction following out-patient band ligation of haemorrhoids. Ann R Coll Surg Engl 88:275–279CrossRefGoogle Scholar
  16. 16.
    Bernal JC, Enguix M, López García J, García Romero J, Trullenque PR (2005) Rubber-band ligation for hemorrhoids in a colorectal unit. A prospective study. Rev Esp Enferm Dig 97(1):38–45CrossRefGoogle Scholar
  17. 17.
    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 90:610–613Google Scholar
  18. 18.
    Bursics A, Morvay K, Kupcsulik P, Flautner L (2004) Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Color Dis 19:176–180CrossRefGoogle Scholar
  19. 19.
    Ramírez JM, Aguilella V, Elía M, Gracia JA, Martínez M (2005) Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids. Rev Esp Enferm Dig 97(2):97–103CrossRefGoogle Scholar
  20. 20.
    Wallis de Vries BM, van der Beek ES, de Wijkerslooth LR, van der Zwet WC, van der Hoeven JA, Eeftinck Schattenkerk M, Eddes EH (2007) Treatment of grade 2 and 3 hemorrhoids with Doppler-guided hemorrhoidal artery ligation. Dig Surg 24(6):436–440CrossRefGoogle Scholar
  21. 21.
    Faucheron JL, Gangner Y (2008) 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 51:945–949CrossRefGoogle Scholar
  22. 22.
    Pol RA, van der Zwet WC, Hoornenborg D (2010) Results of 244 consecutive patients with hemorrhoids treated with Doppler-guided hemorrhoidal artery ligation. Dig Surg 27:279–284CrossRefGoogle Scholar
  23. 23.
    Szmulowicz UM, Gurland B, Garofalo T, Zutshi M (2011) Doppler-guided hemorrhoidal artery ligation: the experience of a single institution. J Gastrointest Surg 15:803–808CrossRefGoogle Scholar
  24. 24.
    Sohn N, Aronoff JS, Cohen FS, Weinstein MA (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182:515–519CrossRefGoogle Scholar
  25. 25.
    Spyridakis M, Christodoulidis G, Symeonidis D et al (2011) Outcomes of Doppler-guided hemorrhoid artery ligation: analysis of 90 consecutive patients. Tech Coloproctol 15(Suppl 1):S21–S24CrossRefGoogle Scholar
  26. 26.
    Yamoul R, Attolou G, Njoumi N, Alkandry S, Tahiri MH (2013) The effectiveness of Doppler controlled hemorrhoidal artery ligation based on preliminaries results. Pan Afr Med J 15:159CrossRefGoogle Scholar
  27. 27.
    Walega P, Scheyer M, Kenig J, Herman RM, Arnold S, Nowak M, Cegielny T (2008) 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(11):2379–2383CrossRefGoogle Scholar
  28. 28.
    Testa A, Torino G (2010) Doppler-guided hemorrhoidal artery ligation (DG-HAL): a safe treatment of II-III degree hemorrhoids for all patients. Could it be potentially also good prophylaxis? Minerva Chir 65(3):259–265Google Scholar
  29. 29.
    Conaghan P, Farouk R (2009) Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery in patients who fail rubber band ligation treatment. Dis Colon Rectum 52(1):127–130CrossRefGoogle Scholar

Copyright information

© Association of Surgeons of India 2018

Authors and Affiliations

  • Adel M. Shehata
    • 1
  • Abdel Fattah Saleh
    • 1
  • Amr Abd El-Hameed El-Heeny
    • 1
    Email author
  1. 1.General Surgery Department, Faculty of MedicineMinia UniversityMinyaEgypt

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