A Randomized Clinical Study to Compare the Outcome of Hemorrhoidal Artery Ligation (HAL) Procedure with and without Doppler Guidance in Grades I–III Hemorrhoidal Disease

Abstract

Hemorrhoidal artery ligation (HAL) procedure aims specifically at reducing the arterial flow to the hemorrhoids. The Doppler probe allows an accurate localization of the branches of superior rectal artery which are individually ligated. However, the vessels can also be ligated by digital palpation of vessels without the help of Doppler probe. In this study, we have compared the results of hemorrhoidal artery ligation procedure with and without Doppler guidance in symptomatic grades I–III hemorrhoids. The study was a single-blinded randomized clinical study. Patients were randomly allocated into two groups, the non-Doppler group (HAL group) and the Doppler group (DGHAL group). The outcome was assessed by using HDSS questionnaire as proposed by Nystrom et al. Patients were followed at 6 weeks, 6 months, and 1 year following the procedure. In this study, the overall control of bleeding was 86.9% (86.0% in HAL group and 87.9% in DGHAL group) after 1 year of follow-up. The overall recurrence of prolapse in patients with grade II hemorrhoids after 1 year of follow-up was 16.9% (17.9% patients in HAL group and 16.0% in DGHAL group). The overall recurrence of prolapse in patients with grade III hemorrhoid after 1 year follow-up was 58.6% (60% patients in HAL group and 57.1% in DGHAL group). However, there was no significant difference between both groups. No significant difference was found in both groups in the secondary outcome measures (pain, soiling, and itching). Our study indicates that the hemorrhoidal artery ligation procedure can be performed effectively without the use of Doppler transducer. The study also suggests that HAL procedure is more effective in early grade hemorrhoids (grades I and II).