2012

“Distal Doppler-guided dearterialization” is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization

Ratto C., Donisi L., Parello A., Litta F., Zaccone G., De Simone V.
Colorectal Disease

AIM
Transanal haemorrhoidal dearterialization (THD® Doppler) is a surgical procedure involving Doppler‐guided ligation of haemorrhoidal arteries to reduce arterial flow. With proximal Doppler‐guided dearterialization, arterial ligation is achieved by introducing the proctoscope completely into the anal canal and lower rectum. In the present study, distal Doppler‐guided dearterialization (DDD) is performed in the distal 2 cm of the lower rectum. Immediate and short‐term results were evaluated.

METHOD
One hundred patients with bleeding haemorrhoids, with or without muco‐haemorrhoidal prolapse, underwent THD® Doppler procedure, using DDD of the haemorrhoidal arteries 2 cm above the anorectal junction. Mucopexy was performed in patients with haemorrhoidal prolapse.

RESULTS
The operation time was 20 ± 7 min for dearterialization alone (10 patients), and 30 ± 10 min when mucopexy was added (90 patients). Morbidity included: transient haemorrhoidal thrombosis (two patients); urinary retention (five patients); submucosal abscess (one patient). No patient complained of faecal incontinence. At a median follow‐up of 7.3 (3–17) months, all patients reported an improvement in symptoms. No patients reported bleeding.

CONCLUSION
DDD of the haemorrhoidal arteries could be a simplified and more effective method of applying THD.

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