Hemo-Dop® - The innovation for a new, operative treatment for Hemorrhoids: The Doppler Guided Hemorrhoid Arterial Ligature Technique (DG-HAL).

Hemorrhoids - a common disease with increasing tendency
Due to the current poor nutritional habits and general lack of exercise, the number of people suffering from hemorrhoids is dramatically increasing. It is estimated that 1% of the Western population visit the doctor every year due to problems associated with hemorrhoids*.
Hemorrhoids, or piles, are essentially varicosities of the venous plexus in the anal canal wall. There is a structural altering of the hemorrhoidal plexus and they descend along the anal canal until they are transient, or fixed in the prolapse position, depending on the degree of hemorrhoid.

Hemorrhoids - Traditional Therapy
Until now, all methods used aim to reduce the circulation and thereby the swelling of the venous plexus, or involve the surgical removal of the hemorrhoids. The reduction of blood circulation is achieved by different methods of sclerotherapy and in the application of a Barron-Ligature. The operative procedures of actually removing the venous plexuses are known as Milligan- Morgan and Parks. The latter procedures, in particular, require a hospital admission, general anaesthesia and are accompanied by considerable post-operative pain.

Hemorrhoids – A New Therapy
A new safe, effective** and pain free technique has been developed for the treatment of hemorrhoids - DG-HAL technique as available with the Hemo-Dop®. The procedure involves stemming the blood flow to the hemorrhoidsby ligaturing the hemorrhoidal supplying arteries, thereby causing the hemorrhoids to shrink and diminish.

DWL, a world leading manufacturer of high quality Doppler ultrasound technology, has utilised its extensive experience to specifically design the Hemo-Dop® for the DG-HAL technique.
The DG-HAL technique enables every experienced surgeon to treat hemorrhoids in an outpatient clinic, without the need for anaesthetic due to the painless nature of the procedure. The method can be recommended for hemorrhoid degrees II and III. It can also be recommended for degree IV when the patient is unable to undergo general anaesthesia. The success rate for the technique lies between 90 and 100% long term. Whilst the Barron-Ligature method has a bleeding complication rate of 5%, the DG-HAL technique has only 0.5%.
Both the experienced surgeon and the surgically experienced proctologist can successfully apply this method. Due to the pain free nature of the procedure, it has particular advantage in the outpatient clinic. The use of the
DG-HAL technique is time saving and economical: it saves the cost intensive inpatient stay over several days; it saves the patient the post operative discomfort of traditional methods, with the patient often returning to work the next day; and there are no additional material costs associated with the procedure, except for the suture thread and needle.

The HAL Procedure with the Hemo-Dop® in Medical Practice.
By Prof. J. Eitenmüller, St. Rochus Hospital, Castrop-Rauxel (Germany) Specialist for General Surgery, Vascular Surgery and Visceral Surgery.
With this new procedure, the feeding artery of the hemorrhoidal plexus can be tracked point by point and be ligated with a special needle and thread using the custom designed proctoscope.
After applying a lubricant, the specialised proctoscope with inlay is inserted into the anus. After removal of the inlay, the viewing window is opened. The
specialised proctoscope can then be twisted and pushed in and out of the rectum with ease. The physician can see the different parts of the mucosa passing by. In this way the linea dentate can be identified and the physician has a good knowledge of the anatomical structures.
After inserting the specialised proctoscope the physician can, with regard to the hemorrhoidal evidence, detect all the feeding arteries with the special integrated 8 MHz Doppler probe. All the large, clearly detectable arteries on the same side as the hemorrhoid must be ligated. It is assumed that there are blood feeding transverse connections, therefore, closely adjacent arteries should be ligated also.

Results**
Morinaga reports the results from 116 patients using Doppler guided RTN-Ligature. One month post treatment 96% experienced no pain, 80% had no prolapse and 95% had no further bleeding. No serious complications were reported. Only 10% had minor complaints when inserting the proctoscope, 12% had minor complaints when performing the ligature, and 12% had minor bleeding after defecation for one week. In the follow up 5 to 12 months post operatively, there were only 3 cases of prolapse.
This is in accordance with my positive experience with the DG-HAL technique and that of other colleagues in personal communication.

* Der Chirurg, Heft 6, Juni 2001, Seite 656
**Morinaga K, Hasuda K, Ikeda T. - 1995, Novelltherapy for internal hemorrhoids: Ligation for the hemorrhoidal artery with newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610 

Hemo-Dop® - Advantages

- Quick and easy treatment
   of II and III degree Hemorrhoids
- Outpatient Clinic
   The need for lengthy and costly inpatient stay no longer required
- Without Anaesthetic
   Ideal for patients at high risk under general anaesthesia and therefore no anaesthesia
   associated complications
- Painless
   The procedure is performed in a pain insensitive area
- Economical
   Quick procedure requiring only suture material as a running cost

Hemo-Dop® - Features

- Custom designed proctoscope with:
   - High quality integrated 8 MHz Doppler probe
   - Adjustable light source
   - Large working area
- Color monitor with FFT display
- Stereo speakers for clear interpretation of arterial flow
- Intuitive user interface
- Integrated patient data base
- 8 MHz CW/PW pencil probe (optional)
- CE (0123)