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Ann Surg. 2012 May;255(5):840-5. doi: 10.1097/SLA.0b013e31824e2bb5.

Hemorrhoidal artery ligation procedure with or without Doppler transducer in grade II and III hemorrhoidal disease: a blinded randomized clinical trial.

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Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.



The aim of this study was to compare the outcome of the hemorrhoidal artery ligation procedure for hemorrhoidal disease with and without use of the provided Doppler transducer.


Hemorrhoidal artery ligation, known as HAL (hemorrhoidal artery ligation) or THD (transanal hemorrhoidal dearterialization) procedure, is a common treatment modality for hemorrhoidal disease in which a Doppler transducer is used to locate the supplying arteries that are subsequently ligated. It has been suggested that the use of the Doppler transducer does not contribute to the beneficial effect of these ligation procedures.


The authors conducted a single-blinded randomized clinical trial and assigned a total of 82 patients with grade II and III hemorrhoidal disease to undergo either a HAL/THD procedure without use of the Doppler transducer (non-Doppler group, 40 patients) or a conventional HAL/THD procedure (Doppler group, 42 patients). Primary endpoint was improvement of self-reported clinical parameters after both 6 weeks and 6 months. This study is registered at and carries the ID number: NTR2139.


After 6 weeks and 6 months in both the non-Doppler and the Doppler group, significant improvement was observed with regard to blood loss, pain, prolapse, and problems with defecation (P < 0.05). The improvement of symptoms between both groups did not differ significantly (P > 0.05), except for prolapse, which improved more in the non-Doppler group (P = 0.047). There were more complications and unscheduled postoperative events in the Doppler group (P < 0.0005). After 6 months, 31% of the patients in the non-Doppler group and 21% in the Doppler group reported completely complaint free (P = 0.313).


The authors' findings confirm that the hemorrhoidal artery ligation procedure significantly reduces signs and symptoms of hemorrhoidal disease. The authors' data also show that the Doppler transducer does not contribute to this beneficial effect.

[Indexed for MEDLINE]

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