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Transanal Hemorrhoidal dearterialisation: non-excisional surgery for the tratment of haemorrhoidal disease.

Authors: P. P. Dal Monte, C. Tagariello, P. Giordano, E. Cudazzo, A. Shafi, M. Sarago, M. Franzini.

Source: Techniques in Coloproctology, Volume 11 - Number 4 - December 2007.

As in life... In their quest for the truth, men make two steps ahead and one behind. Suffering, errors and boredom push them backwards, but thirst for the truth and obstinate will, pushes them forwards. And who knows? Perhaps they will find the truth.

Anton Checov

Abstract Background Transanal haemorrhoidal dearterialisation (THD) is a nonexcisional surgical technique for the treatment of piles, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the haemorrohoidal plexus. The aim of this study was to assess the long term efficacy of this treatment.

Methods The procedure was carried out using a proctoscope with a Doppler probe. The terminal branches were located with Doppler and then sutured.

Results from January 2000 to May 2006, we performed THD in 330 patients (180 men; mean age, 52.4 years), including 138 second-degree, 162 third degree and 30 fourth-degree hemorrhoids. There were 23 postoperative complications (7 cases of bleeding, 5 thrombosed piles, 4 rectal haematomas, 2 anal fissures, 2 cases of dysuria, 1 of haematuria and 2 needle ruptures) The mean postoperative pain score was 1.32 on a visual analog scale. 219 patients were followed for a mean of 46 months (range, 22-79), including 100 patients with second-degree, 104 with third-degree and 15 with fourth-degree haemorrhoids. The operation completely resolved the symptoms in 132 patients (92.5%) with preoperative bleeding and in 110 patients (92%) with preoperative prolapse.

Conclusions The efficacy and relapse rate of this procedure appears to be similar to that of traditional surgery of stapled haemorrohoidopexy. The technique was effective and safe for all degrees of haemorrhoids because of the excellent results, low complication rate and minor postoperative pain.