Our indications for treatment by this method are the same as for radical surgery, i.e. symptomatic second and third degree hemorrhoids and patients with first degree hemorrhoids who are bleeding excessively resulting in Anemia. Our results show this method for the treatment of hemorrhoids to be, I believe, highly successful, with minimum side effects or complications.

It would appear that the cause of failure of this method is solely due to inadequate ligation of the terminal branches of hemorrhoidal (superior rectal) arteries. In those cases where the treatment had been unsuccessful, it became obvious immediately or within the first four weeks after treatment. Thereafter, (four weeks after treatment) only a small number (27) recurred. We believe that most of these (27) cases are due to the hemorrhoids receiving a major arterial contribution from the middle or inferior hemorrhoidaI arteries. Because these arteries enter low down, they are unable to be ligated. These vessels could be clearly seen on duplex scanning.

The only other problem which we have encountered is in patients who had suffered chronic symptoms of hemorrhoids and have developed large indurated skin tags. Although even these tags will shrink noticeably, they will not disappear completely and may have to be surgically removed. However, these skin tags are easily dealt with under local anaesthetic.