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

Abstract

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.