Transanal hemorrhoidal dearterialization: Lessons learned from a personal series of 200 consecutive cases and a proposal for a tailor-made procedure

Sobrado, Carlos Walter; Hora, José Américo Bacchi; Sobrado, Lucas Faraco; Frugis, Marcos Onofre; Nahas, Sérgio Carlos; Cecconello, Ivan

doi:10.1016/j.amsu.2020.05.036

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…In this present study, none of the patients required opioid for pain control and we had 10% of postoperative tenesmus, which is a substantial improvement in comparison to our previous results with complete dearterialization and mucopexy guided by Doppler, in which 26% of patients had tenesmus and 14% required opioids for pain control 8 .…”

Section: Figure 1 -Reusable Pivot Proctoscopecontrasting

confidence: 45%

A New Approach for Hemorrhoid Disease: Selective Dearterialization and Mucopexy Without Doppler Guidance

Sobrado

Nahas

et al. 2021

ABCD, arq. bras. cir. dig.

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Background: Transanal hemorrhoidal dearterialization (THD) is safe and effective minimally invasive treatment for hemorrhoidal disease, but reports regarding recurrence and postoperative complications (pain and tenesmus) vary significantly. Aim: To evaluate if selective dearterialization and mucopexy at the symptomatic hemorrhoid only, without Doppler guidance, achieves adequate control of the prolapse and bleeding and if postoperative morbidity is reduced with this technique. Methods: Twenty consecutive patients with grade II and III hemorrhoids were treated with this new approach and were evaluated for postoperative complications and recurrence. Results: Control of prolapse and bleeding was achieved in all patients (n=20). Postoperative complications were tenesmus (n=2), external hemorrhoidal thrombosis (n=2) and urinary retention (n=2). After a mean follow-up of 13 months no recurrences were diagnosed. Conclusion: Selective dearterialization and mucopexy is safe and achieves adequate control of prolapse and bleeding and, by minimizing sutures in the anal canal, postoperative morbidity is diminished. Doppler probe is unnecessary for this procedure, which makes it also more interesting from an economic perspective.

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Section: Figure 1 -Reusable Pivot Proctoscopecontrasting

confidence: 45%

A New Approach for Hemorrhoid Disease: Selective Dearterialization and Mucopexy Without Doppler Guidance

Sobrado

Nahas

et al. 2021

ABCD, arq. bras. cir. dig.

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“…Gupta et al, on his study in 2011, reported that the suture ligation of hemorrhoids is a simple, cost-effective, and convenient modality for treating Grade 3 hemorrhoids. Doppler assistance in ligating the hemorrhoidal vessels before hemorrhoidal mucopexy offers no advantage and is a time-consuming procedure, although another study did not support them and still suggested the standard Doppler guided in performing hemorrhoid artery ligation with rectoanal repair [9], [12].…”

Section: Discussionmentioning

confidence: 99%

Three Years Recurrence Free of Hemorrhoid Artery Ligation-Rectoanal Repair with No Doppler Guided on Grade III of Internal Hemorrhoid Disease

Bagus

2023

Open Access Maced J Med Sci

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BACKGROUND: Surgical treatment of internal hemorrhoid is still challenging, short- and long-term clinical outcome were the most common issue. Chronic pain and recurrence case are the most common problem. Since it has been announced, HAL-RAR with Doppler guided is the treatment of choice, although it has economic issue on using this standard technique especially in the developing country which has limitation on health insurance. AIM: Using the same procedure as the standard HAL-RAR procedure and direct vision ligation, we hope that it could evaluate the clinical response of these modification technique on symptomatic Grade III of internal hemorrhoid cases. METHODS: We will evaluate the long-term clinical outcome of modified no Doppler guided technique on grade III of internal hemorrhoid cases. The inclusion criteria are the grade III of internal hemorrhoid, not associated with rectal cancer. A history of previous procedure or recurrence disease will be excluded from the study. Post-operative pain, 3 years recurrence disease, will be evaluated. RESULTS: We reported 65 patients, both of them have pain and bleeding. The procedure can be performed safely using direct vision and rectoscope. After 3 years, we reported there was no recurrence disease, no post-operative bleeding, and tolerable post-operative pain. We reported one case of chronic pain due to proctitis and could be managed conservatively. CONCLUSION: No Doppler-guided HAL-RAR was effective in controlling the post-operative pain, acceptable long-term clinical outcome with no recurrence.

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“…This technique was developed specifically to reduce postoperative complications, such as pain, and has undergone a series of refinements that have broadened its indications and improved its outcomes. The surgical technique is not standardized, and the results for advanced hemorrhoidal disease are controversial [4]. The success rate for THD varies based on the severity of hemorrhoidal disease and the specific surgical technique employed.…”

Section: Discussionmentioning

confidence: 99%

Horseshoe Abscess as a Rare Complication After Transanal Hemorrhoid Dearterialization With Mucopexy: A Case Report

Nakao,

Reeves,

Denning

et al. 2023

Cureus

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Transanal hemorrhoidal dearterialization (THD) is a minimally invasive procedure that has gained popularity as a treatment for symptomatic hemorrhoids. It involves ligating the arterial blood supply to the hemorrhoidal plexus. Compared to conventional ligation or resection, THD is associated with less postoperative bleeding and pain, allowing for same-day surgery discharge. Horseshoe abscess is a rare but known complication of anorectal surgery, characterized by an abscess that extends around the anal canal, often involving the ischiorectal fossa and adjacent structures. Although horseshoe abscesses have been reported after various anorectal surgeries, including hemorrhoidectomy, their occurrence following THD has not been well-documented in the literature.A 72-year-old male underwent THD for rectal prolapse with internal hemorrhoids and presented to the hospital on postoperative day 6 with severe rectal pain. A computed tomography (CT) scan revealed a large complex horseshoe perirectal abscess with fluid and air and significant rectal wall thickening. A rectal examination under anesthesia confirmed the presence of purulent drainage from the anus, and surgical drainage of the abscess was performed. The patient received antibiotics and analgesics and experienced a favorable recovery.The exact pathophysiology of a horseshoe abscess following THD remains unclear, and the incidence and risk factors associated with this complication are not well-established. Moreover, there has yet to be a consensus on the optimal management of horseshoe abscesses after THD, whether through surgical or medical approaches. This case emphasizes the importance of considering horseshoe abscess as a potential complication of THD and highlights the need for further research to understand better its incidence, risk factors, and optimal management strategies.

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Transanal hemorrhoidal dearterialization: Lessons learned from a personal series of 200 consecutive cases and a proposal for a tailor-made procedure

Cited by 8 publications

References 21 publications

A New Approach for Hemorrhoid Disease: Selective Dearterialization and Mucopexy Without Doppler Guidance

A New Approach for Hemorrhoid Disease: Selective Dearterialization and Mucopexy Without Doppler Guidance

Three Years Recurrence Free of Hemorrhoid Artery Ligation-Rectoanal Repair with No Doppler Guided on Grade III of Internal Hemorrhoid Disease

Horseshoe Abscess as a Rare Complication After Transanal Hemorrhoid Dearterialization With Mucopexy: A Case Report

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