Doppler-Guided Haemorrhoidal Artery Ligation (HAL) and its Effectiveness in Achieving Patient Satisfaction in Haemorrhoidal Bleeding

Background: Doppler-guided Haemorrhoid Artery Ligation (HAL) of the terminal branches of the superior haemorrhoidal artery is an increasingly popular technique in haemorrhoid management. Objectives: The aim was to assess the role of Doppler HAL in haemorrhoid management, patient outcomes and satisfaction. Materials and Methods: The study was a prospective case series, analysed retrospectively. Seventy-eight consecutive patients undergoing Doppler HAL for Grade III and IV haemorrhoids at a single metropolitan private hospital in Sydney, Australia were included in the study. A modified proctoscope housing a Doppler transducer was used to sequentially suture ligate the haemorrhoidal arteries. The authors report our preliminary experience with regards to post-operative symptoms, re-intervention requirements and overall patient satisfaction with the procedure and symptom management. Results: The predominant pre-operative symptom was haemorridal bleeding. First follow-up was four weeks post-procedure. The minimum follow-up was at 1, 3 and 18 months. First follow-up showed 55 patients had no bleeding at all (71%), with most patients also having no pain (78%). Six patients underwent further intervention (8%). Short to medium term follow-up at 3 to 18 months showed 65 patients were satisfied with the procedure (84%). Of those surveyed beyond 18 months, 66 patients had no bleeding or bleeding less than once per month (89%), and satisfaction scores were high at 88%. Further intervention was reported in 24 patients (32%). Only a total of 4 patients (5%) progressed to requiring a haemorrhoidectomy.