Doppler‐guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial

Abstract

Aim This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome.Method Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni-and multivariate analyses of the potential predictive factors for failure were performed.Results The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 AE 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively.Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Dopplerguided dearterialization were associated with a better outcome.Conclusion THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.Keywords Haemorrhoids, haemorrhoidal disease, rectal bleeding, prolapse, transanal haemorrhoidal dearterialization, multivariateWhat does this paper add to the literature? To our knowledge this is the largest series ever published on the topic of Doppler-guided transanal haemorrhoidal dearterialization. This paper describes the changes in the technique that there have been over the years, and their impact on the results in short-and long-term follow-up. A detailed multivariate analysis of the potential predictive factors of failure is provided.

Hemorrhoidal Artery Ligation With Recto-Anal Repair Versus Traditional Hemorrhoid-Ectomy, a Comparative Study

“…This is same with the results obtained by the above studies. This study revealed no difference between the two groups with respect to postoperative complications and recurrent prolapse after 1 year; The same results were obtained by different studies such as Ratto C et al 17 . Also this study revealed disturbance of the ano-rectal function in the form of urgency, tenesmus, flatus incontinence, more in the hemorrhoidectomy group B but it was not statistically significant, and these symptoms were disappeared after one month from surgery, this result is same as study done by Elshazly WG 18 .…”

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

“…THD or DGHAL is a treatment option for II-and IIIdegree haemorrhoids and in experienced hands possibly also for IV degree [18,108,109]…”

Hemorrhoidal Disease, from Legacy to a Change of Perspective

“…New studies about physiology published by Morinaga in 1995, at the beginning ignored by great part of surgical community, but with the merit of switching attention form the technical approach to the physiological cause of hemorrhoidal disease and its evolution: vascularization. After more or less 10 years and the development of surgical devices that are dedicated to operate with a standard technique, the Transanal Hemorrhoidal Desarterialization stepped up as a new and minimally invasive approach for the treatment of hemorroids [20][21][22][23][24][25][26][27][28].…”