Doppler-guided hemorrhoidal artery ligation with hemorrhoidopexy: source and prevention of postoperative pain

Rubbini, Michele; Tartari, V

doi:10.1007/s00384-015-2148-3

Cited by 11 publications

(6 citation statements)

References 17 publications

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“… Ratto et al [ 24 ] 803 (grades: 2–3–4) 34.3 ± 5.9 (24–47) 6 13 2.2 0.5 0.1 11.1 ± 9.2 (3–57) 9.3 3.0 6.9 0 5.6 LaBella et al [ 25 ] 108 (grades 2–3–4) n.a. 6 8 13 0 0 12 10.3 0 10.3 0 10.3 Rubbini et al [ 26 ] 106 (grades 3–4) 25 (16–65) n.a. 35 n.a.…”

Section: Discussionmentioning

confidence: 99%

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature

et al. 2017

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BackgroundThe transanal hemorrhoidal dearterialization (THD) Doppler procedure is a minimally invasive technique to treat symptomatic hemorrhoids. The aim of the study was to assess the clinical efficacy and the satisfaction of patients in a large series treated with THD and to review the relevant literature.MethodsIn this retrospective, single-institution, study consecutive patients with grade 2, 3, or 4 hemorrhoidal disease were treated with the THD Doppler procedure. Dearterialization was performed in all cases and mucopexy in case of prolapse. The dearterialization procedure evolved from “proximal artery ligation” to “distal Doppler-guided dearterialization.” Follow-up was scheduled at 15 days, 1, 3, 12 months, and once a year thereafter. Complications were recorded. Clinical efficacy was assessed comparing both frequency of symptoms and disease grading (Goligher’s classification) at baseline versus last follow-up. Uni-/multivariate analysis evaluated factors affecting the outcome.ResultsThere were 1000 patients (619 men; mean age: 48.6 years, range 19–88 years). Acute postoperative bleeding was observed in 14 patients (1.4%), pain/tenesmus in 31 patients (3.1%), and urinary retention in 23 patients (2.3%). At mean follow-up duration of 44 ± 29 months, the symptomatic recurrence rate was 9.5% (95 patients; bleeding in 12 (1.2%), prolapse in 46 (4.6%), and bleeding and prolapse in 37 (3.7%) patients). The recurrence rate was 8.5, 8.7, and 18.1% in patients with grade 2, 3, and 4 hemorrhoids, respectively. Seventy out of 95 patients with recurrence needed surgery (reoperation rate: 7.0%). At final follow-up and taking into account the reoperations, 95.7% of patients had no hemorrhoidal disease on examination. Younger age, grade 4 disease, and high artery ligation affected the outcome negatively.ConclusionsOur results show that the THD Doppler procedure is safe and effective in patients with hemorrhoidal disease and associated with low morbidity and recurrence rates and a high rate percentage of treatment success.

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Section: Discussionmentioning

confidence: 99%

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature

et al. 2017

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“…Tenesmus occurred in 21.4% (151/705), is generally transitory within the first two postoperative weeks. The inflammatory process (triggered by the various mucopexy sutures in the low rectum and the consequent local ischaemia and edema) may explain both tenesmus and local discomfort 28,30 . The greater the number of running sutures involving the anal canal mucosa and submucosa, the greater the feeling of tenesmus and pain, and the higher the possibility of ischaemia will be 30 .…”

Section: /5mentioning

confidence: 99%

“…The inflammatory process (triggered by the various mucopexy sutures in the low rectum and the consequent local ischaemia and edema) may explain both tenesmus and local discomfort 28,30 . The greater the number of running sutures involving the anal canal mucosa and submucosa, the greater the feeling of tenesmus and pain, and the higher the possibility of ischaemia will be 30 . During the mucopexy procedure, the longitudinal sutures should be performed separately from each other, thus preserving a band of normal mucosa between them, with the aim of ensuring adequate arterial irrigation of the low rectum and anal canal, preventing ischaemia and external haemorrhoidal thrombosis.…”

Section: /5mentioning

confidence: 99%

Transanal Haemorrhoidal Dearterialization With Mucopexy (Thd-M) for Treatment of Hemorrhoids: Is It Applicable in All Grades? Brazilian Multicenter Study

Sobrado

Klajner

Hora

et al. 2020

ABCD, arq. bras. cir. dig.

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Background: Transanal haemorrhoidal dearterialization with mucopexy (THD-M) is a valuable option for treating patients with haemorrhoidal disease. However, there is still controversy with regard to its efficacy for more advanced grades. Aim: To evaluate the effectiveness of THD-M technique for treating hemorrhoidal disease and to compare the immediate and late results in different grades. Method: Seven hundred and five consecutive patients with Goligher’s grade II, III or IV symptomatic haemorrhoids underwent surgical treatment using the THD-M method in five participating centres. Six well-trained and experienced surgeons operated on the patients. Average follow-up was 21 months (12-48). Results: Intraoperative complications were observed in 1.1% of cases, including four cases of haematoma, two of laceration of the mucosa, and two of bleeding. All of these were controlled by means of haemostatic suturing. In relation to postoperative complications, the most common of these were as follows: transitory tenesmus (21.4%); pain (7.2%); mucosal or haemorrhoidal prolapse (6.4%); residual skin tag (5.6%); faecal impaction (3.2%); haemorrhoidal thrombosis (2.8%); bleeding (2.1%); anal fissure (0.7%); and anal abscess (0.3%). Most of the complications were treated conservatively, and only 7.5% (53/705) required some type of surgical approach. There was no mortality or any severe complications. The recurrence of prolapse and bleeding was greater in patients with grade IV haemorrhoidal disease than in those with grade III and II (26.54% and 7.96% vs. 2.31% and 0.92% vs. 2.5% and 1.25%), respectively. Conclusion: The THD-M method is safe and effective for haemorrhoidal disease grades II and III with low rates of surgical complications. However, for grade IV hemorrhoids, it is associated with higher recurrence of prolapse and bleeding. So, THD-M method should not be considered as an effective option for the treatment of grade IV hemorrhoids.

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“…2), as confirmed by the current literature. 16,17,28,29 The lower pain scores associated with LA might be explained by the placement of sutures in the non-sensitive anal mucosa above the dentate line, 30 as well as the absence of surgical wounds. The registration of higher VAS score after OH was explained by the thermal effect of diathermy, the presence of wounds in the sensitive anal mucosa, and anal spasm.…”

Section: Discussionmentioning

confidence: 99%

Impact of Ambulatory Surgery for Hemorrhoidal Disease on Clinical Outcomes and Institutional Costs

Ascanelli

Solari

Rubbini

et al. 2021

Journal of Coloproctology

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Objective Transanal hemorrhoidal artery ligation with mucopexy (ligation anopexy [LA]) and open hemorrhoidectomy (OH) can both be performed under local anesthesia. The aim of the present study was to analyze the impact and the cost-effectiveness of performing these techniques in an ambulatory setting of an Italian academic center on the postoperative outcome. Methods A series of 122 consecutive patients with grades II and III hemorrhoidal disease undergoing ambulatory surgical treatment of hemorrhoids in 2015 to 2018 (group A) was compared with 122 patients operated at the same institution in the same period (group H) in a hospital setting.The primary outcome was the number of days required to return to work/daily activities. Secondary outcomes included postoperative pain and complications, cost-effectiveness, patient satisfaction, and recurrence at 12 months. In group A, all the procedures were performed under local anesthesia with early discharge. In group H, the procedures were performed under general or loco-regional anesthesia with hospital admission. Results The mean number of days required to return to work/daily activities was 8.4 ± 4.8 days in group A, compared with 12.5 ± 3 days in group H (p < 0.001). The visual analog scale (VAS) pain score at 1 week, 2 and 3 weeks, and 1 month after surgery was lower for patients undergoing LA in the ambulatory setting (p < 0.01). We observed more postoperative complications in hospitalized (12.5%) than in ambulatory patients (7.5%) (p < 0.001). The total mean direct costs per patient were significantly lower in the ambulatory setting versus the hospital stay group (351.3 versus 1,746 euros). Conclusion Implementing ambulatory surgery for hemorrhoids is feasible, safe, and cost-effective.

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Doppler-guided hemorrhoidal artery ligation with hemorrhoidopexy: source and prevention of postoperative pain

Abstract: The review of the causes of postoperative pain and the changes adopted compared with those proposed in literature have allowed us to greatly reduce postoperative pain.

Cited by 11 publications

References 17 publications

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature

Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature

Transanal Haemorrhoidal Dearterialization With Mucopexy (Thd-M) for Treatment of Hemorrhoids: Is It Applicable in All Grades? Brazilian Multicenter Study

Impact of Ambulatory Surgery for Hemorrhoidal Disease on Clinical Outcomes and Institutional Costs

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