{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:50:35Z","timestamp":1761897035753,"version":"3.40.5"},"reference-count":15,"publisher":"Wiley","issue":"7-8","license":[{"start":{"date-parts":[[2019,7,1]],"date-time":"2019-07-01T00:00:00Z","timestamp":1561939200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ANZ Journal of Surgery"],"published-print":{"date-parts":[[2019,7]]},"abstract":"Background<\/jats:title>Some authors, either with anatomical studies or Doppler laser flowmetric investigations have shown the blood flow to the posterior midline of the anus to be potentially deficient. This relative local ischaemia might explain pathogenesis of anal fissure, which is often located posteriorly. The aim of this study was to record the exact position of the distal branches of the superior rectal artery during Doppler\u2010guided haemorrhoidal artery ligation\u2010rectoanal repair (HAL\u2010RAR) procedures with special reference to posterior distribution of the arteries.<\/jats:p><\/jats:sec>Methods<\/jats:title>All consecutive patients with symptomatic haemorrhoids who were treated with the HAL\u2010RAR procedure between February 2008 and February 2014 in a single institution were included in the study. Number and position of Doppler\u2010guided ligations were prospectively collected. Pearson's chi\u2010squared test was used to compare artery locations.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 150 patients (75 women) with symptomatic haemorrhoids were included in the study. Median age was 53\u2009years (range 23\u201383). A median of 10 ligations were placed per patient (range 3\u201318). A significantly lower number of cumulative arterial ligations was recorded in the posterior position (88 ligations overall, P<\/jats:italic>\u2009=\u20090.025).<\/jats:p><\/jats:sec>Conclusions<\/jats:title>The number of distal branches of the superior rectal artery that have been localized by the Doppler\u2010guided HAL\u2010RAR technique is lower at the posterior midline than in the other segments of the lower rectum. This is another evidence of the vascular deficiency at the posterior pole of the anal canal that might explain the pathogenesis of the anal fissure.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.15143","type":"journal-article","created":{"date-parts":[[2019,7,2]],"date-time":"2019-07-02T00:29:57Z","timestamp":1562027397000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Assessment of haemorrhoidal artery network using Doppler\u2010guided haemorrhoidal artery ligation for haemorrhoids and pathogenesis implications"],"prefix":"10.1111","volume":"89","author":[{"given":"Bertrand","family":"Trilling","sequence":"first","affiliation":[{"name":"Colorectal Unit, Department of Surgery Michallon University Hospital Grenoble France"},{"name":"UMR 5525, CNRS, TIMC\u2010IMAG, University Grenoble Alps Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian","family":"Mancini","sequence":"additional","affiliation":[{"name":"Colorectal Unit, Department of Surgery Michallon University Hospital Grenoble France"},{"name":"UMR 5525, CNRS, TIMC\u2010IMAG, University Grenoble Alps Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Reche","sequence":"additional","affiliation":[{"name":"Colorectal Unit, Department of Surgery Michallon University Hospital Grenoble France"},{"name":"UMR 5525, CNRS, TIMC\u2010IMAG, University Grenoble Alps Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hannah","family":"Pflieger","sequence":"additional","affiliation":[{"name":"Colorectal Unit, Department of Surgery Michallon University Hospital Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pierre\u2010Yves","family":"Sage","sequence":"additional","affiliation":[{"name":"Colorectal Unit, Department of Surgery Michallon University Hospital Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0837-2277","authenticated-orcid":false,"given":"Jean\u2010Luc","family":"Faucheron","sequence":"additional","affiliation":[{"name":"Colorectal Unit, Department of Surgery Michallon University Hospital Grenoble France"},{"name":"UMR 5525, CNRS, TIMC\u2010IMAG, University Grenoble Alps Grenoble France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,7]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF02554725"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.1800830120"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2008.01729.x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2002.11.003"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/bjs.7700"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-008-9201-z"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e318201d31c"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/codi.12303"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2003.07423.x"},{"key":"e_1_2_8_11_1","first-page":"29","article-title":"Annual report of the Italian coloproctology units","volume":"3","author":"Pescatori M","year":"1995","journal-title":"Tech. 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