Hemorrhoidal Artery Ligation
The Doppler-controlled hemorrhoidal artery ligation (HAL) is a surgical procedure for the surgical treatment of abnormally enlarged hemorrhoids .
It is a relatively new, minimally invasive procedure that promises less pain and faster healing compared to traditional operations.
Field of application (indication)
For 2nd or 3rd degree hemorrhoids. In contrast to circular procedures, such as Longo staple hemorrhoidopexy , it does not matter whether all three or only individual segments are to be treated.
history
First presented in 1995 in Japan by Kazumasa Morinaga , this method is based on the development of a new type of surgical device , called the Moricorn by its inventors . This is similar to a proctoscope and includes in its top an ultrasonic - sensor (Dopplertransducer).
technology
The procedure focuses on a relatively insensitive area of the rectum above the dentate line . More precisely, on the arteries located there, which supply the hemorrhoidal cushions, which are located directly below in the area of the sensitive anal mucosa , with blood. First the special proctoscope (approx. 25 mm in outer diameter) developed especially for this treatment is inserted into the anal canal. With the help of the ultrasonic sensor and a small light source in the tip of the instrument, the arteries are precisely located, pierced with a needle that is passed through a window in the surgical device, and finally tied with a snare. In this way, between three and five tributaries are shut down one after the other. The underserved node then begins to swell.
A further development of the hemorrhoidal artery ligature is the transanal hemorrhoidal artery ligature (THD).
course
The treatment can be carried out without anesthesia. It is only sometimes necessary to use medication to immobilize the patient (e.g. using lidocaine gel). The procedure is mostly carried out on an outpatient basis , but sometimes the patient remains in the hospital for observation for the following night. Some surgeons prefer to close only a few arteries and, if necessary, perform follow-up treatment after four weeks.
The procedure takes between 15 and 25 minutes.
Success is relatively short-term and, according to the first American and Australian studies, occurs in 90 to 95% of all cases. Rare pain and discomfort due to the procedure usually subside after a few days, if necessary a mild pain reliever can help. The ability to work is usually given immediately, at the latest the next day.
Risks and Complications
Bleeding or infection as a result of the procedure is extremely rare, but can be significant in patients with a pre-existing bleeding disorder. Fecal incontinence or sphincter muscle injuries, which are occasionally observed as a consequence of operations in other procedures, have not yet been detected using this method. The first study results are available. The immediate effectiveness in relation to the existing symptoms is good. About 2/3 of the patients become symptom-free postoperatively. However, 40% of them experience symptoms again after three to four years. The guidelines of the German Society for Coloproctology do not yet evaluate the hemorrhoidal artery ligation due to insufficient studies.
Relapse
Compared to other procedures in which tissue is removed, haemorrhoid symptoms are more likely to recur in the period after the treatment, which means that the recurrence rate is slightly higher. However, the treatment can easily be repeated.
Individual evidence
- ↑ K. Morinaga, K. Hasuda, T. Ikeda: A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter . In: American Journal of Gastroenterology . . 90, No. 4, April 1995, pp. 610-613. PMID 7717320 .
- ^ S1 guideline for hemorrhoidal diseases of the German Society for Coloproctology. In: AWMF online (as of 07/2008)
