Clinical outcome after Doppler-guided hemorrhoidal artery ligation and rubber-band ligation for the treatment of primary symptomatic hemorrhoids

Objective: The aim of this study was 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. Patients and methods: Fifty patients with symptomatic grade II and grade III uncomplicated internal hemorrhoids were randomly assigned to be treated with either RBL or DG-HAL. Patients were assessed clinically for postoperative complications and recurrence through 6 months after surgery. Results: Preoperative characteristics were similar between the two groups. The main preoperative complaint was protrusion of piles followed by bleeding. The overall rate of complications was 16% after RBL (9.1% for grade II and 21.4% for grade III) and 4% after DG-HAL (6.7% for grade II and 0% for grade III) (P = 0.07). The overall rate of recurrence was 12% after RBL (9.1% for grade II and 14.3% for grade III) and 4% after DG-HAL (0% for grade II and 10% for grade III) (P = 0.2). All complications were conservatively controlled with no need for reintervention. At the end of 6 months of follow-up, the overall freedom from symptoms was 88% after RBL (90.9% for grade II and 85.7% for grade III) and 96% after DG-HAL (100% for grade II and 90% for grade III). With regard to grade of hemorrhoids (II or III), there were statistically insignificant differences between the two procedures in terms of recurrence and complications. Conclusion: DG-HAL is safer and effective compared with RBL in the treatment of grade III hemorrhoids; however, in grade II patients, both procedures had nearly equal rate of complications despite no recurrence with DG-HAL.