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Farbcodierte Dopplersonographie des Anorektums

Ist die dopplergesteuerte Hämorrhoidenarterienligatur effektiv?

Color-coded Doppler sonography of the anorectum

Is Doppler-guided hemorrhoidal artery ligation effective?

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coloproctology Aims and scope

Zusammenfassung

Hintergrund

Das vordringlichste Ziel in der Therapie des Hämorrhoidalleidens bei Hämorrhoiden Grad 1 und 2 besteht in der Beseitigung der transanalen Blutungen und des Prolapses bei fortgeschrittenen Stadien. Neben den klassischen konservativen Verfahren, wie Sklerosierung und Gummibandligatur sowie den bekannten operativen Maßnahmen, bieten neuere Verfahren ein mehr pathogenetisch orientiertes Vorgehen an. Hierzu zählt die Reduzierung des arteriellen Flow in das Corpus cavernosum recti innerhalb des Analkanals. Die dopplergesteuerte Hämorrhoidenarterienligatur (DG-HAL) bietet sich als wirkungsvolle Alternative an. Fraglich ist, ob die Ligatur der zuführenden Arterie suffizient ist oder der Erfolg der Methode auf Sekundärmechanismen wie Fibrosierung oder Fixation der Mukosa beruht.

Material und Methode

Im Rahmen einer prospektiven Studie wurden 15 konsekutive Patienten präoperativ und in definierten postoperativen Intervallen, 10 Tage und 3 Monate, nach HAL/RAR postoperativ mittels 3D-Endosonographie und farbcodierter Dopplersonographie untersucht.

Ergebnisse

Es zeigte sich, dass die HAL die Hauptstämme der zuführenden Arterien in das Corpus cavernosum recti wirksam unterbinden konnte. Auch nach 3 Monaten war dieser Effekt nachweisbar. Kleinere Residualgefäße blieben hiervon unberührt.

Schlussfolgerung

Zusammenfassend kann festgestellt werden, dass die DG-HAL den arteriellen Zufluss in das Corpus cavernosum recti wirkungsvoll unterbinden kann. Postoperative farbcodierte Doppleruntersuchungen belegen dies.

Abstract

Background

The highest priority in treating hemorrhoids is the alleviation of transanal bleeding and prolapse in advanced stages. In addition to the traditional surgical methods, which are always associated with excision of hemorrhoidal tissue, newer methods offer a more pathogenetically oriented approach. In addition to stapled hemorrhoidopexy, reduction of the arterial flow into the corpus cavernosum of the rectum and reduction of mucosal prolapse and parts of the hemorrhoids to the regular site within the anal canal can also be used. The hemorroidal artery ligation (HAL) rectoanal repair (RAR) method is an effective alternative. It is questionable whether ligation of the artery is sufficient or success of the method is due to secondary mechanisms, such as fibrosis or fixation of the mucosa.

Material and Methods

In a prospective study 15 patients were examined preoperatively and postoperatively at defined intervals following HAL/RAR using 3D endosonography and color-coded Doppler sonography.

Results

It was found that the DG-HAL could effectively prevent the main trunks of the afferent arteries connecting to the corpus cavernosum of the rectum and was maintained even after 3 months. Smaller residual vessels remained unaffected.

Conclusion

The DG-HAL method can effectively stop arterial inflow into the corpus cavernosum of the rectum and was demonstrated by postoperative color-coded Doppler studies.

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Interessenkonflikt

Der korrespondierende Autor weist für sich und seine Koautoren auf folgende Beziehungen hin: HAL-Hospitationen für Fa. AMI. US-Kurse in Zusammenarbeit mit BK-Medical. Honorare wurden auf Drittmittel-Konto gezahlt.

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Authors and Affiliations

  1. Koloproktologische Klinik, Klinikverbundes St. Antonius und St. Josef, Vogelsangstr. 106, 42109, Wuppertal, Deutschland

    P. Prohm FASCRS, M. Kowallik & T. Kuruc

Authors
  1. P. Prohm FASCRS
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  2. M. Kowallik
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  3. T. Kuruc
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Corresponding author

Correspondence to P. Prohm FASCRS.

Additional information

Die Ergebnisse wurden auszugsweise auf dem Tripartite-Meeting in Cairns, Australien 2011, vorgestellt.

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Prohm, P., Kowallik, M. & Kuruc, T. Farbcodierte Dopplersonographie des Anorektums. coloproctology 34, 124–130 (2012). https://doi.org/10.1007/s00053-012-0273-9

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  • DOI: https://doi.org/10.1007/s00053-012-0273-9

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