Die dopplergeführte Hämorrhoidalarterien-Ligatur

Hintergrund und Fragestellung: Seit Anfang 2001 wurden in unserer Klinik nahezu alle Patienten mit einem Hämorrhoidalleiden durch die dopplergeführte Hämorrhoidalarterien-Ligatur (DG-HAL) versorgt. Uns interessierte die Frage, ob der Eingriff tatsächlich ohne Narkose durchgeführt werden kann, die Hämorroidalknoten sich zurückbilden und Vorteile gegenüber den klassischen Methoden der Therapie des Hämorrhoidalleidens bestehen.

Patienten und Methodik: Berichtet wird über erste Erfahrungen mit der dopplergeführte Hämorrhoidalarterien-Ligatur an 248 Patienten. Mit einem speziellen Proktoskop werden die zu den Hämorrhoidalpolstern führenden Arterien im schmerzfreien Anteil des Rektums doppler gesteuert aufgesucht und umstochen. Berichtet wird über Narkoseform, Operationsdauer, Anzahl und Lokalisation der Ligaturen, Nebeneingriffe und perioperative Komplikationen.

Ergebnisse: 69 % der Patienten konnten ohne Narkose operiert werden. 147 Patienten wurden 6 Wochen nach dem Eingriff nachuntersucht. 61,2 % der Patienten waren beschwerdefrei, 87,7 % zumindest gebessert. Die Komplikationsrate war gering.

Folgerung: Die DG-HAL Methode ist nach unseren Erfahrungen eine wenig belastende, komplikationsarme und erfolgreiche Methode zur ambulanten Therapie des Hämorrhoidalleidens. Die ideale Indikation sind nicht-prolabierende Hämorrhoiden.

Background and objective: Since the beginning of 2001, Doppler-giuded ligation of the hemorrhoidal arteries (DG-HAL) has been used at this clinic in almost all patients with various forms of hemorrhoidal disease. Aim of this study was to ascertain wether this intervention can be done without general anaesthesia, the hemorrhoidal knots regress and this procedure provides advantages over the classical methods of treating hemorrhoids.

Patients and methods: Early results of DG-HAL in 248 patients are presented. Through a special proctoscope the arteries leading to the hemorrhoidal cushions are located in the pain-free rectum under Doppler guidance and suture ligated. The form of anaesthesia, duration of the operation, numbers and sites of the ligatures, additional interventions and postoperative complications were recorded.

Results: 171 patients (69%) needed no anaethesia. 147 patients (Without additional interventions) were re-examined 6 weeks after the operation: 61.2% were free of symptoms. A total of 87.7% were at least improves. The complication rate was low.

Conclusion: In our experience DG-HAL has been a well tolerated efficacious method with few complications in the ambulatory treatment of hemorrhoids. The ideal indication for this methods is nonprolapsing hemorrhoids.

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