Emergency transanal haemorrhoidal <scp>D</scp>oppler guided dearterialization for acute and persistent haemorrhoidal bleeding

Cavazzoni, Emanuel; Bugiantella, Walter; Graziosi, Luigina; Franceschini, Maria Silvia; Cantarella, Francesco; Rosati, Emanuele; Donini, Annibale

doi:10.1111/codi.12053

Cited by 15 publications

(8 citation statements)

References 20 publications

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“…With the patient in the lithotomy position, the proctoscope was fully introduced transanally to reach the lower rectum. Under Doppler guidance, six arterial signals were found at 6-7 cm from the anal verge, mostly at 1, 3,5,7,9,11 o'clock of the rectal circumference. The traditional approach to make the 'dearterialization' involves the transfixion of rectal mucosa and submucosa with a 'Z-stitch' to entrap the artery; this dearterialization modality is here defined as 'high ligation'.…”

Section: Surgical Techniquementioning

confidence: 99%

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

Ratto

Parello

Veronese³

et al. 2014

Colorectal Disease

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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.

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Section: Surgical Techniquementioning

confidence: 99%

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

Ratto

Parello

Veronese³

et al. 2014

Colorectal Disease

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“…Transanal hemorrhoidal dearterialization (THD) is a relatively recent minimally invasive treatment for symptomatic hemorrhoids and may have important advantages over conventional hemorrhoidectomy [ 16 – 18 ]. Its application toward the control of rectal outlet bleeding has been previously realized [ 19 ]. However, outcomes with patients on anticoagulation who have undergone THD have not been previously reported, to our knowledge.…”

Section: Introductionmentioning

confidence: 99%

Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient?

et al. 2016

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BackgroundApproximately one in five persons living in the USA is maintained on oral anticoagulation. It has typically been recommended that anticoagulation be withheld prior to hemorrhoidal procedures. Transanal hemorrhoidal dearterialization (THD) is a minimally invasive treatment for symptomatic hemorrhoids, and outcomes with patients on anticoagulation who have undergone this procedure have not been previously reported. Here, we report our preliminary results of patients who underwent THD while on anticoagulation.MethodsDuring a 53-month period (February 2009–July 2015), patients with symptomatic hemorrhoids refractory to medical management who underwent surgical treatment with THD were retrospectively reviewed. The subset of patients who underwent THD while anticoagulated was compared to a cohort of patient who were not taking anticoagulation and who otherwise demonstrated normal coagulation profiles and who did not have a known predisposition to bleeding or inherited coagulopathy. The primary study endpoint was to assess postoperative bleeding in patients who were maintained on anticoagulation before and after surgery.ResultsDuring the 53-month study period, 106 patients underwent the THD procedure for symptomatic hemorrhoids. Of these, seventy patients underwent THD without anticoagulation therapy, while 36 patients underwent THD while taking one or more oral anticoagulants. The postoperative morbidity between the two cohorts was similar, and specifically there was no statistical difference in the rate of postoperative hemorrhage (19.4 vs. 15.7 %; odds ratio 1.295, 95 % CI 0.455–3.688, p = 0.785). No patient, in either cohort, required re-intervention for any reason during the study period. Patients who underwent THD while on anticoagulation were less likely to have recurrent hemorrhoidal disease during the study’s 6-month median follow-up period (2.8 vs. 7.1 %, p = 0.049).ConclusionsThese preliminary data reveal that THD can be performed on anticoagulated patients without cessation of oral agents without increasing morbidity from postoperative bleeding.

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“…Open hemorrhoidectomy is also the most suitable option for patients with strangulated internal prolapsed if it is to be managed surgically. Emergency surgery has proved to be a safe management option (Kaidar-Person et al 2007) although others have proposed new alternatives in the emergency scenario (Cavazzoni et al 2013).…”

Section: Milligan-morgan or Excisionalmentioning

confidence: 99%

“…In that sense, patients having received sclerotherapy may be bad candidates for mucopexy. Emergency bleeding control in high risk patient on antiplatelet has also been successful (Cavazzoni et al 2013;Ratto et al 2015).…”

Section: Arterial Ligation and Mucopexymentioning

confidence: 99%

Selection of Patients to the Surgical Treatment of Hemorrhoids

Kreisler¹,

Biondo²

2017

Hemorrhoids

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Some patients with prominent hemorrhoids will present with symptoms requiring some kind of treatment. Although a majority of patients will be successfully managed by conservative treatment and office procedures, some will need an operation. Surgical indication is mainly settled after failure or contraindication of local treatments or in Grade III and IV hemorrhoids. Several surgical strategies have been proposed and can be graded by their effectiveness and complications rates. Patients need to be informed on those on the basis of their main symptoms and general and proctologic baseline health. After a full assessment of patients and their haemorrhoidal condition, a number of issues have to be considered and discussed in order to plan a tailored strategy for each specific scenario that balances benefits and risks with adjusted patient expectations. General concepts that need to be understood by patients and surgeons when dealing with hemorrhoids are summarized. Different criteria to assess patients' condition and to choose surgical operation are discussed. Finally, the rationale to individualize treatment strategies for different grades of hemorrhoids is presented.

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Emergency transanal haemorrhoidal Doppler guided dearterialization for acute and persistent haemorrhoidal bleeding

Abstract: THD is effective in controlling acute haemorrhoidal bleeding with a low incidence of postoperative complications.

Cited by 15 publications

References 20 publications

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

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

Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient?

Selection of Patients to the Surgical Treatment of Hemorrhoids

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