Hemorrhoidal artery ligation without using a doppler guide: Is it a feasible and safe technique?

The objective of this work was to analyze the results of the hemorrhoidal artery ligation technique without using a doppler guide, in patients with grade 3 hemorrhoidal disease; by evaluating cost-effectiveness, operation time, recurrence rate, postoperative pain, and secondary outcomes. A hemorrhoidal artery ligation procedure, without using a doppler guide, was performed on 43 patients (15 females, 28 males) with grade 3 symptomatic hemorrhoidal disease, from June 2015 to June 2019, in the Haseki Training and Research Hospital, Istanbul, Turkey. Patients were followed up clinically for one month. They completed a questionnaire within one year after their procedure. The median age was 46 years (range: 24 to 82 years). The main complaints were bleeding in 27 patients, pain in 22 patients, and skin tag in 14 patients. The mean preoperative VAS score was 3.4. The mean operating time was 18 mins (range: 13 to 25 min). All patients remained hospitalized for 24 h. Reoperation was necessary for only one patient because of bleeding. One year after the surgery, the pain was resolved in 21 (95.4%) out of 22 patients with preoperative pain, and bleeding resolved in 25 (92.5%) out of 27 patients with preoperative bleeding. The hemorrhoidal artery ligation is a simple method with a shorter learning curve producing similar postoperative results to other surgical procedures. The surgical technique is cost-effective as it does not require any particular device (anoscope with Doppler ultrasound) to apply.