International Partner Meeting/Oct. 2013Schwarzenberg/Austria

The importance of using A.M.I. Doppler technology for the treatment of hemorrhoids

Klaus Langer

Why is it important to use a Doppler?

Take advantage of several presentations which were already given in the past, referring to actual literature, demonstrating the importance of using a Doppler

Today, there is agreement within the colorectal society

….on the influencing factor of afferent blood vessels (arteries) into the hemorrhoidal plexus for the development of enlarged hemorrhoids and the importance of hemorrhoidal artery ligation.

Surgeons talk about:

- Impaired venous drainage, - malfunction of arteriovenous shunts- vascular hyperplasia - enlarged arteries- imbalance of vascular in and outflow- etc

This is already a big achievement!

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In the past hemorrhoids was meant to be a purely venous disease

Hemorrhoidal Artery Ligation is nothing new!!!

HAL and HemorrhoidectomyParks 1956:

“The operation should aim at the removal of the dilated veins, ligation of the hemorrhoidal arteries and fixation of the anal mucosa to the underlying muscle (internus) to prevent prolapse and to obliterate the submucous space”.

HAL and HemorrhoidectomyParks 1956:

“The operation should aim at the removal of the dilated veins, ligation of the hemorrhoidal arteries and fixation of the anal mucosa to the underlying muscle (internus) to prevent prolapse and to obliterate the submucous space”.

Since hemorrhoidal artery ligation is so important……

Let’s look again at hemorrhoidectomy!

Milligan-Morgan, Parks, Ferguson

HAL

HAL

HAL

Milligan-Morgan, Parks, Ferguson

HAL

HAL

HAL

Milligan-Morgan, Parks, Ferguson

HAL

HAL

HAL

Milligan-Morgan, Parks, Ferguson

Milligan-Morgan, Parks, Ferguson

??

?

?Could this cause recurrence?

Hemorrhoidectomy and Recurrencies

Reported success rates mostly cover the complication of a re-prolapse – but what about the symptoms? Think about what hurts a patient!!

Hemorrhoidectomy and Recurrencies

70% / 67%

Milligan-Morgan, Parks, Ferguson

??

?

?

Hemorrhoidectomy and Recurrence!

Is there a co-relation between the number of hemorrhoidal

artery ligations and the recurrence rate after hemorrhoidectomy?

To improve the success rate of HE – should it be combined

with HAL?

Quick Answers – if our HAL Doppler is questioned

Let’s be a little provocative: Do you give surgical treatment to patients which first have gone through

rubber band ligation? – Well, if the patient expects a similar result as RBL, than you will not need

a Doppler! You never want to close a major vein to further obstruct blood back flow,

don’t you! If you (surgeon) find a heavy bleeding during surgery, will you stop it just by

guessing, or will you first find out where exactly it is? Experienced HAL-RAR users practice extensive and precise hemorrhoidal

artery ligation. For long lasting results they consider it to be more important than mucopexy. They strongly suggest that in very rare cases when hemorrhoidectomy

(partial) needs to be done, to always combined with HAL.