Summary Objective The goal of this study was to prospectively evaluate the surgical management of hemorrhoids by Doppler-guided hemorrhoidal artery ligation (Doppler HAL™). Patients and methods This study was conducted between April 2008 and September 2009. The Doppler HAL™ technique was performed in patients with grades II to IV, irrespective of whether they had previously undergone medical or instrumental management or not. The other demographics of the studied population, the operative and post-operative results as well as the functional outcome at one month and at one year were recorded prospectively and analyzed retrospectively. Results Sixty-one consecutive patients (mean age 45 [range 28–85]) underwent Doppler HAL™. The mean duration of operation was 26minutes [range 18–45]. The average number of ligations per patient was seven. Three patients left the hospital the same day, 51 patients were discharged on day 1 and five patients on day 2. Post-operative mortality was nil. The post-operative morbidity rate was 4.9%. Functional results evaluated at one month and one year showed that initial symptoms had disappeared in more than 78% of patients. The recurrence rate for hemorrhoidal related disease was 10.5% during the first year. Conclusion Surgical treatment of hemorrhoids by the Doppler-guided hemorrhoidal artery ligation technique is mini-invasive, with low morbidity, and satisfactory short and medium term functional results. This technique represents a reliable surgical alternative to classical hemorrhoidectomy and hemorrhoidopexy in the therapeutic strategy of hemorrhoidal disease.