الفهرس 
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Abstract
Haemorrhoidal disease (HD) is the most common type of anorectal disorder seen in proctology clinic. It affects between 4.4 and 36.4% of the general population. It is a condition with a variety of symptoms and a spectrum of severity.
The prevalence of hemorrhoids is equal between men and women, but men are more likely to seek treatment; moreover, the prevalence of hemorrhoids also increases with age until the seventh decade, at which point there appears to be a slight decline.
Based on the degree of the prolapse, It may be classified into four grades. Grade I hemorrhoids are non-prolapsing, grade II hemorrhoids prolapse on straining but reduce spontaneously, grade III hemorrhoids require manual reduction, and grade IV hemorrhoids are non‐reducible.
Although the majority of patients with grade I and II hemorrhoids can be effectively managed with conservative treatment, surgical intervention is required for patients with advanced stages of hemorrhoids.
While hemorrhoidectomy remains the gold-standard approach for grade IV hemorrhoids, several minimally invasive treatment options, such as Doppler-guided hemorrhoidal artery ligation (DGHAL), have been introduced for the management of grade III hemorrhoids, aiming at overcoming the disadvantages associated with hemorrhoidectomy, including severe postoperative pain and complications such as anal stricture.
DGHAL was introduced in 1995 by Morinaga et al. This method requires the use of a proctoscope with a Doppler transducer attached to detect the location and depth of arterial structures.
Since DGHAL does not involve tissue excision, it is expected to be associated with reduced postoperative pain.
This observational prospective study was conducted on 30 consecutive patients presenting for haemorrhoidectomy to evaluate the DGHAL technique in management of grade III hemorrhoids. This study was performed on patients of grade 3 hemorrhoids either diagnosed for the first time or already diagnosed before, who were referred to outpatient department. The patients had been followed-up weekly for one month then monthly for two months to evaluate ongoing symptoms and postoperative complications.
Our study reported that, the mean age of study groups was (40.93±6.10) years. Regarding gender, the majority of patients were males (80%).
The median of intraoperative bleeding was 32.50 ml with range (25-60) ml. The median of operative time was 12 mins with range (10-20) mins. Regarding hospital stay, the median of period was 8 hours with range (6-22) hours. There was a significant gradual decrease in postoperative pain score in the 1st 3 weeks postoperative, however, there was no significant difference between scores from 3rd to 4th week (median values = 3, 1.5, 0 & 0) respectively (p=0.006).
In conclusion, Doppler-guided hemorrhoid artery ligation procedure should be considered in management of cases with symptomatic or prolapsed hemorrhoids rather conventional hemorrhoidectomy. It is safer, minimal-invasive surgical treatment for hemorrhoidal disease with lesser short- and long-term complications.
Due to its clinical importance, more randomized comparative clinical trials with larger sample size and more data are needed for further evaluation of study outcomes and assessment the late recurrence.