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Hépato-Gastro & Oncologie Digestive

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Doppler-guided haemorrhoidal artery ligation: age of maturity? Volume 19, issue 9, Novembre 2012

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Authors
Centre hospitalier Diaconesses-Croix Saint-Simon, service de proctologie médico-interventionnelle 18 rue du Sergent Bauchat 75012, Paris, Hôpital Saint-Antoine service de gastroentérologie et nutrition 184 rue du Faubourg Saint-Antoine 75012 Paris, Hôpital Bagatelle service de proctologie 203 Route de Toulouse 33401 Talence Cedex, Groupe Hospitalier Paris Saint-Joseph, Institut de proctologie Léopold Bellan, 185 rue Raymond Losserand, 75014 Paris

Hypervascularization of the anorectum is increasingly thought to play a major role in the pathogenesis of internal haemorrhoidal disease. It supports haemorrhoidal artery ligations as a therapeutic approach, firstly published more than 15 years ago but which has recently the subject of a growing interest. Many case series have been published assessing haemorrhoidal artery ligations, with or without recto-anal repair, reporting good results in the short and medium term. Operation time, hospitalization and time before recovering were short. Efficacy in terms of bleeding, pain and prolapse control was superior to 80 % or even 90 %, excepting for grade IV haemorrhoids. Eventually, the technique was painless and morbidity was very low. Comparative trials with other surgical techniques (stapled haemorrhoidopexy or haemorrhoidectomy) are scarce and have several limitations. Preliminary data suggest that Doppler-guided haemorrhoidal artery ligations are superior to stapled haemorrhoidopexy in terms of postoperative pain, length of stay and maybe regarding complications. Effectiveness appears similar but long term results are still needed. Unanswered questions remain about precise indications, long-term effectiveness and actual contribution of the Doppler use. Finally, we would like to underscore the intake of recto-anal repair which, although it has not been specifically studied, seems critical.