Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience

Abstract

Background There is an increasing, though still limited, amount of evidence describing the use of the transanal hemorrhoidal dearterialization (THD) device for the treatment of hemorrhoidal disease. This study assesses postoperative outcomes from a single surgeon experience with the THD device.MethodsFrom January 2009 to December 2011, 108 THD procedures were performed. With Doppler guidance, the THD device makes possible precise ligation of the branches of the superior hemorrhoidal artery. Patients were seen postoperatively at 3 weeks and 6 months. They underwent physical examination to determine whether there was recurrence of hemorrhoidal prolapse. They were asked to describe any bleeding, to rate pain using the visual analog scale, and to rate their level of satisfaction on a scale of 1–5 (with 5 = highly satisfied). A phone interview was used for follow-up at 1 year to determine the rate of recurrent prolapse.ResultsOf the 108 patients who underwent THD, two were lost to follow-up and excluded. All of the remaining 106 patients completed follow-up at 3 weeks and 6 months. At 3 weeks, 92 % of patients had no pain and 88 % were highly satisfied with the procedure at 3 weeks. This increased to 92 % satisfaction at 1 year. Prolapse recurrence was 7.5 % at 6 months and 10.3 % at 1 year. Bleeding was the most common complication, but did not require re-intervention or transfusion.ConclusionsTHD is a same-day procedure for the treatment of hemorrhoidal disease that is safe and effective, and offers the potential for immediate return to normal activity.

Harmonic scalpel versus conventional haemorrhoidectomy for grade III and IV haemorrhoids: a randomized controlled trial

“…This data is quite consistent with other studies in literature. [8][9][10][11] The intraoperative blood loss was 1.59 gauzes in harmonic haemorrhoidectomy as against 3 to 4 gauzes in open haemorrhoidectomy this difference was statistically significant in the present study and if we were to consider one completely soaked gauze piece to be equal to 5 ml of blood 9 the average blood loss in harmonic haemorrhoidectomy was 5ml as against 15 to 20 ml in open haemorrhoidectomy. The present study did not do weighing of gauze pieces to calculate blood loss.…”

“…These results are also consistent with literature except one study La Bella et al which had almost all patients with swelling coming out of anus and 86% patients having pain during defecation, probably due to selection of Grade IV haemorrhoids. 8 A total of 62.5%patients in the present study had Grade III haemorrhoids and 37.5% had Grade IV haemorrhoids. This data is quite consistent with other studies in literature.…”

Transanal Hemorrhoid Dearterialization and mucopexy: a minimal invasive approach for prolapsed hemorrhoids. Four cases report.

“…Milligan-Morgan (open) and Ferguson (closed) hemorrhoidectomy techniques are still considered the gold-standard for the operative management of advanced hemorrhoids [4]. However, these procedures are associated with postoperative complications including infection, ano-rectal stenosis, incontinence, urinary retention, severe rectal bleeding and postoperative pain [4,6,18].…”

“…When hemorrhoids are associated with bleeding, pruritus, mucous discharge per rectum or prolapse, they are referred as symptomatic and in the presence of symptom associations they are referred to as "hemorrhoidal disease" [2][3][4]. Even though they are probably one of the most common causes of anal pathology, the true prevalence of hemorrhoids is difficult to establish, because many patients don't seek medical care.…”

“…It was first described by Morinaga et al [12] and since then the technique and the operative equipment have been improved. THD procedure involves ligation of the hemorrhoidal arteries under Doppler guidance resulting in reduced inflow that facilitates reduction in size of hemorrhoids, while suture mucopexy addresses the prolapsed mucosa [4]. Kjaer et al…”