Doppler-guided hemorrhoidal artery ligation versus digital-guided ligation in management of second-degree and third-degree hemorrhoids

Background
Hemorrhoids are veins normally located in the lower part of the rectum and anus of the human body that assist in continence. Hemorrhoidal disease is a common anorectal disorder. It is estimated that 39% of the general population is affected.
Aim
To compare the results of Doppler-guided hemorrhoidal artery ligation and digital-guided ligation in the management of second-degree and third-degree hemorrhoids and their early and late complications.
Patients and methods
This is a comparative randomized prospective study. The required sample size was estimated to be 80 patients complaining of second-degree or third-degree hemorrhoids according to the Goligher classification. They were divided into two groups: group A (Doppler-guided group) included 40 patients, and group B (digital-guided group) included 40 patients. The patients were assigned to either of the group in a random manner using the sealed envelope system.
Results
In our study, the rate of bleeding recurrence in Doppler-guided hemorrhoidal artery ligation group was 2.5% and the rate of prolapse recurrence was 5% compared with 5% bleeding recurrence and 7.5% prolapse recurrence in the finger-guided group. There was no significant difference between the two groups in early or late postoperative complications, as well as in patient satisfaction or visual analog scale of pain after surgery.
Conclusion
There was no significant difference between Doppler-guided hemorrhoidal artery ligation and finger-guided ligation of the hemorrhoidal artery. Both methods are feasible and could be applied as an alternative to the standard hemorrhoidectomy with great clinical outcome.