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) ( = 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) ( = 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.