ORIGINAL ARTICLE Doppler-Guided Hemorrhoidal Artery Ligation: The Experience of a Single Institution Ursula Maria Szmulowicz & Brooke Gurland & Thomas Garofalo & Massarat Zutshi Received: 6 November 2010 / Accepted: 1 February 2011 / Published online: 26 February 2011 # 2011 The Society for Surgery of the Alimentary Tract Abstract Purpose This study aims to review the short-term recurrence and complications of Doppler-guided hemorrhoidal artery ligation (DG-HAL) with mucopexy. Methods Approval was obtained for a retrospective chart review of patients who underwent DG-HAL from January 2007 to June 2009. A treatment failure was recorded if internal hemorrhoids were noted at follow up or symptoms persisted. All recurrences were assessed for predictive factors. Results The procedures were performed by four surgeons. Ninety-six patients were included. The average age was 63.5 years (21–81 years). The mean follow up was 15 months (3–35 months). Of the patients, 93 (96.8%) reported bleeding pre-operatively. Mucopexy accompanied DG-HAL in 87 (90.6%). Postoperative complications occurred in nine (9%) patients. Residual hemorrhoids were evident in 20 (21%) patients, 13 of whom required further management for symptomatic disease, five with DG-HAL. Fifty percent (10/20) and 70% (9/13) of the recurrences necessitating further treatment transpired during the first 20 procedures of each surgeon. All 13 symptomatic recurrences demonstrated large, circumferential internal hemorrhoids. Conclusions DG-HAL is a simple procedure with a low complication rate. Recurrences are more frequent during the learning curve. Patients with large, circumferential internal hemorrhoids should be counseled about a possible higher rate of recurrence. DG-HAL can be effectively repeated for recurrences. Keywords Hemorrhoids . Arterial ligation . Mucopexy . Recurrence . Circumferential Introduction “Hemorrhoids” is a ubiquitous complaint among Amer- icans, indicating symptoms and signs as varied as rectal bleeding, perianal itching, anal pain, prolapse, a sensa- tion of incomplete evacuation, and mucus discharge. After the age of 50 years, approximately 50% of individuals will experience symptoms attributable to hemorrhoidal disease. 1 The true prevalence of hemor- rhoidal disease is difficult to gauge but is estimated to range from 4.4% to 36.4%. 2, 3 As many as 1 million Americans are afflicted each year. 1 The standard options to manage hemorrhoidal disease have long included office-based procedures such as sclerotherapy, rubber band ligation, and cryotherapy as well as surgical This study was funded by the Cleveland Clinic Foundation, Digestive Disease Institute, Department of Colorectal Surgery, 9500 Euclid Avenue, Cleveland, Ohio 44195. This study was a poster presentation at the annual meeting of the American Society of Colon and Rectal Surgeons, Minneapolis, Minnesota, May 15–19, 2010 and was also a podium presentation at the annual meeting of the Association of Coloproctology of Great Britain and Ireland, June 28–30, 2010. Assistance for travel to the meeting of the Association of Coloproctology of Britain and Ireland was provided by AMI for one author. U. M. Szmulowicz : B. Gurland : T. Garofalo : M. Zutshi Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, OH, USA U. M. Szmulowicz (*) Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic Foundation, 16761 SouthPark Center/ST-20, Strongsville, OH 44136, USA e-mail: szmulou@ccf.org J Gastrointest Surg (2011) 15:803–808 DOI 10.1007/s11605-011-1460-7