الفهرس 
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Abstract
The ideal surgical treatment for HD can be defined as safe, painless, and minimally invasive with minimal costs.(Infantino et al .,2012).
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.
.(Rinaldi et al :2001 ; Morinage et al :1995 ; Tjandra et al
:2007).
Numerous modalities and techniques have been developed to treat symptomatic hemorrhoids. First- and second degree hemorrhoids can be treated conveniently on an outpatient basis by means of sclerotherapy, photocoagulation, cryotherapy, and rubber band ligation, while third degree or severely prolapsed or circumferential hemorrhoids can be treated using the Milligan– Morgan hemorrhoidectomy or stapled hemorrhoidectomy
.(Gupta et al :2008).
Numerous studies have proven that rubber band ligation is best suited for grade I and grade II hemorrhoids, while when used in grade III hemorrhoids, return of symptoms in the long term affects more than 11% . ( Longman et al .,2006 ).
LUV is a safe and easily applied alternative technique with low postoperative complications for the surgical treatment of
symptomatic Grade II and III hemorrhoidal disease ..( Kara et al
.,2015) .
The technique is based on the fact that most of the hemorrhoidal vessels have a constant anatomical location. Usually, they penetrate the hemorrhoid pile at the base. A stitch that transfixes the base of the prolapsing hemorrhoid is able to diminish the blood flow to the hemorrhoidal plexus significantly.And if this is followed by plication of the entire prolapsing hemorrhoid, the prolapse is controlled as well.
Several studies attempt to show that THD results in markedly reduced postoperative pain pain and quicker return to normal
.activity.(Giordano et al., 2009;Pucher et al .,2013 ; Denoya et al .,2014).
Recent studies have reported that LUV of symptomatic haemorrhoids is a simple and safe haemorrhoids and as additional procedure in the treatment of complex perianal pathology.(Issa et al :2008).
.It is a simple technique which does not require special equipment and may be performed in the day-care operating Room.
Thus, the present study calls into question the value of Doppler-assisted localization of vessels in hemorrhoid operations and implies that hemorrhoids can be managed with equal efficacy without the need of the costly Doppler instruments, with less operative time, and with reduced postoperative pain.
So , our conclusion that ligation under vision -of third degree hemorrhoids- is a simple technique which does not require special equipment and may be performed in the day-care
operating Room.