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AimTransanal haemorrhoidal dearterialization (THD) has become well established for the treatment of haemorrhoids. In this study we describe a technical modification of this technique, targeted mucopexy (THD TM), and report the results for advanced haemorrhoids.MethodThe study included a prospective evaluation of patients with Grade IV (fourth-degree) haemorrhoids operated on with the THD TM technique. This consisted of an initial dearterialization when the haemorrhoidal arteries were transfixed and a second phase of mucopexy, using a different needle from that usually used in the original technique.ResultsFrom January 2007 to December 2011, 31 consecutive patients with Grade IV haemorrhoids were operated on using the THD TM technique. Postoperative pain was reported by 22 (70%) patients on day 1 and 19 (61%) on day 7, while nine (30%) did not experience any pain at all. Severe pain was reported by only nine (16%) patients. At a mean follow-up of 32 months, two (6.4%) patients required a further intervention for on-going symptoms.ConclusionTransanal haemorrhoidal dearterialization TM is effective for advanced haemorrhoids.What does this paper add to the literatureThis paper describes a technical modification of the original transanal haemorrhoidal dearterialization technique introduced by the senior author and reports the results achieved with it in patients with Grade IV haemorrhoids. We believe the modification has allowed a significant improvement in the outcome, especially when dealing with advanced haemorrhoids.

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