Advertisement

Comparison of Doppler-Guided Transanal Hemorrhoidal Dearterialization for Grade III and IV Hemorrhoids in Vietnam

  • Le Manh CuongEmail author
  • Tran Thu Ha
  • Nguyen Ngoc Anh
  • Nguyen Tien Thanh
  • Vu Duy Kien
  • Nguyen Duc Lam
Original Research

Abstract

Introduction

This study aimed to assess the short- and long-term outcomes of Doppler-guided transanal hemorrhoidal dearterialization (THD) for grade III and IV hemorrhoidal disease in Vietnam.

Methods

In a prospective observational design, patients treated for grade III and IV hemorrhoidal disease with the THD method at the National Hospital of Traditional Medicine (Hanoi, Vietnam) were included between June 2012 and December 2013. Patients were evaluated postoperatively at the time they were discharged from the hospital (short-term outcome) and 6 months after surgery (long-term outcome).

Results

A total of 128 patients were enrolled in the study, 94 were classified with grade III disease and 34 with grade IV. Grade IV hemorrhoidal patients reported on average 18.2 years of disease symptom duration, while grade III hemorrhoidal patients reported 11.2 years. All patients with grade III and grade IV hemorrhoidal disease had good outcomes at discharge day and reported to return to work in a median of 6 days after THD. At long-term follow-up, the results were good for 80.9% of patients from grade III hemorrhoidal disease and 61.8% of patients from grade IV hemorrhoidal disease. Patient satisfaction with the procedure and outcomes was 93.6% for grade III and 85.3% for grade IV hemorrhoidal patients.

Conclusions

The THD technique was shown to be safe for both grade III and IV hemorrhoidal patients. The THD technique showed better results with grade III hemorrhoidal patients as compared to grade IV hemorrhoidal patients.

Keywords

Dearterialization Doppler-guided THD Hemorrhoidal artery ligation Hemorrhoids Vietnam 

Notes

Acknowledgements

The authors thank patients and healthcare professionals who participated in this study.

Funding

No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

The authors (Le Manh Cuong, Tran Thu Ha, Nguyen Ngoc Anh, Nguyen Tien Thanh, Vu Duy Kien and Nguyen Duc Lam) have nothing to disclose.

Compliance with Ethics Guidelines

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Military Medical University committee, Vietnam and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval to conduct the study was obtained from the committee of the Military Medical University, Vietnam by the Decision no. 2858/QD-HVQY. Informed consent was obtained from all individual participants included in the study.

Data Availability

The datasets generated during and/or analyzed during the current study are available in the Figshare repository,  https://doi.org/10.6084/m9.figshare.7560437.

References

  1. 1.
    Kaidar-Person O, Person B, Wexner SD. Hemorrhoidal disease: a comprehensive review. J Am Coll Surg. 2007;204(1):102–17.  https://doi.org/10.1016/j.jamcollsurg.2006.08.022.CrossRefGoogle Scholar
  2. 2.
    Ganz RA. The evaluation and treatment of hemorrhoids: a guide for the gastroenterologist. Clin Gastroenterol Hepatol. 2013;11(6):593–603.  https://doi.org/10.1016/j.cgh.2012.12.020.CrossRefGoogle Scholar
  3. 3.
    Tournu G, Abramowitz L, Couffignal C, et al. Prevalence of anal symptoms in general practice: a prospective study. BMC Fam Pract. 2017;18(1):78.  https://doi.org/10.1186/s12875-017-0649-6.CrossRefGoogle Scholar
  4. 4.
    Ratto C, Campenni P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017;21(12):953–62.  https://doi.org/10.1007/s10151-017-1726-5.CrossRefGoogle Scholar
  5. 5.
    Kandilarov N, Dimitrova V. Hemorrhoidal disease—contemporary aspects of the pathogenesis, clinical course, diagnosis and treatment. Khirurgiia (Sofiia). 2015;81(1):38–56.Google Scholar
  6. 6.
    Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist’s view. World J Gastroenterol. 2015;21(31):9245–52.  https://doi.org/10.3748/wjg.v21.i31.9245.CrossRefGoogle Scholar
  7. 7.
    Higuero T, Abramowitz L, Castinel A, et al. Guidelines for the treatment of hemorrhoids (short report). J Visc Surg. 2016;153(3):213–8.  https://doi.org/10.1016/j.jviscsurg.2016.03.004.CrossRefGoogle Scholar
  8. 8.
    Shaikh AR, Dalwani AG, Soomro N. An evaluation of Milligan-Morgan and Ferguson procedures for haemorrhoidectomy at Liaquat University Hospital Jamshoro, Hyderabad, Pakistan. Pak J Med Sci. 2013;29(1):122–7.  https://doi.org/10.12669/pjms.291.2858.Google Scholar
  9. 9.
    Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol. 2014;18(3):291–8.  https://doi.org/10.1007/s10151-013-1062-3.CrossRefGoogle Scholar
  10. 10.
    Ratto C, de Parades V. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: a technique for the future. J Visc Surg. 2015;152(2 Suppl):S15–21.  https://doi.org/10.1016/j.jviscsurg.2014.08.003.CrossRefGoogle Scholar
  11. 11.
    Figueiredo MN, Campos FG. Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: technical evolution and outcomes after 20 years. World J Gastrointest Surg. 2016;8(3):232–7.  https://doi.org/10.4240/wjgs.v8.i3.232.CrossRefGoogle Scholar
  12. 12.
    Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S. Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis. 2014;16(5):373–6.  https://doi.org/10.1111/codi.12574.CrossRefGoogle Scholar
  13. 13.
    LaBella GD, Main WP, Hussain LR. Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience. Tech Coloproctol. 2015;19(3):153–7.  https://doi.org/10.1007/s10151-015-1269-6.CrossRefGoogle Scholar
  14. 14.
    Giamundo P. Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids. World J Gastrointest Surg. 2016;8(1):1–4.  https://doi.org/10.4240/wjgs.v8.i1.1.CrossRefGoogle Scholar
  15. 15.
    Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017;21(5):337–44.  https://doi.org/10.1007/s10151-017-1620-1.CrossRefGoogle Scholar
  16. 16.
    Hoyuela C, Carvajal F, Juvany M, et al. HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up. Int J Surg. 2016;28:39–44.  https://doi.org/10.1016/j.ijsu.2016.02.030.CrossRefGoogle Scholar
  17. 17.
    Tsunoda A, Takahashi T, Kusanagi H. A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids. Tech Coloproctol. 2017;21(8):657–65.  https://doi.org/10.1007/s10151-017-1673-1.CrossRefGoogle Scholar
  18. 18.
    Xu L, Chen H, Lin G, Ge Q, Qi H, He X. Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Tech Coloproctol. 2016;20(12):825–33.  https://doi.org/10.1007/s10151-016-1551-2.CrossRefGoogle Scholar
  19. 19.
    Haskins IN, Holzmacher J, Obias V, Agarwal S. The use of transanal hemorrhoidal dearterialization for treatment of hemorrhoid disease at a single institution. Am Surg. 2016;82(12):1160–2.Google Scholar
  20. 20.
    Lwanga SK, Lemeshow S, World Health Organization. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991.Google Scholar
  21. 21.
    Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V. Distal Doppler-guided dearterialization’ is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis. 2012;14(11):e786–9.  https://doi.org/10.1111/j.1463-1318.2012.03146.x.CrossRefGoogle Scholar
  22. 22.
    Bjelanovic Z, Draskovic M, Veljovic M, Lekovic I, Karanikolas M, Stamenkovic D. Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease. Cir Esp. 2016;94(10):588–94.  https://doi.org/10.1016/j.ciresp.2016.07.002.CrossRefGoogle Scholar
  23. 23.
    Elmer SE, Nygren JO, Lenander CE. A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum. 2013;56(4):484–90.  https://doi.org/10.1097/DCR.0b013e31827a8567.CrossRefGoogle Scholar
  24. 24.
    Leardi S, Pessia B, Mascio M, Piccione F, Schietroma M, Pietroletti R. Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) versus stapled hemorrhoidopexy (SH) in the treatment of third-degree hemorrhoids: clinical results at short and long-term follow-up. J Gastrointest Surg. 2016;20(11):1886–90.  https://doi.org/10.1007/s11605-016-3220-1.CrossRefGoogle Scholar
  25. 25.
    Infantino A, Altomare DF, Bottini C, et al. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis. 2012;14(2):205–11.  https://doi.org/10.1111/j.1463-1318.2011.02628.x.CrossRefGoogle Scholar
  26. 26.
    Emile SH, Elfeki H, Sakr A, Shalaby M. Transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) in treatment of internal hemorrhoids: a systematic review and meta-analysis of randomized clinical trials. Int J Colorectal Dis. 2019;34:1–11.CrossRefGoogle Scholar
  27. 27.
    Festen S, Van Hoogstraten M, Van Geloven A, Gerhards M. Treatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results. Int J Colorectal Dis. 2009;24(12):1401.CrossRefGoogle Scholar
  28. 28.
    Giarratano G, Toscana E, Toscana C, Petrella G, Shalaby M, Sileri P. Transanal hemorrhoidal dearterialization versus stapled hemorrhoidopexy: long-term follow-up of a prospective randomized study. Surg Innov. 2018;25(3):236–41.CrossRefGoogle Scholar
  29. 29.
    Giordano P, Nastro P, Davies A, Gravante G. Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol. 2011;15(1):67–73.CrossRefGoogle Scholar
  30. 30.
    Venturi M, Salamina G, Vergani C. Stapled anopexy versus transanal hemorrhoidal dearterialization for hemorrhoidal disease: a three-year follow-up from a randomized study. Minerva Chir. 2016;71(6):365–71.Google Scholar
  31. 31.
    Verre L, Rossi R, Gaggelli I, Di CB, Tirone A, Piccolomini A. PPH versus THD: a comparison of two techniques for III and IV degree haemorrhoids. Personal experience. Minerva Chir. 2013;68(6):543–50.Google Scholar
  32. 32.
    Tempel MB, Pearson EG, Page M, et al. Survey of patient satisfaction after Doppler-guided transanal hemorrhoidal dearterialization performed in ambulatory settings. Tech Coloproctol. 2014;18(6):607–10.  https://doi.org/10.1007/s10151-013-1104-x.CrossRefGoogle Scholar
  33. 33.
    Tsunoda A, Kiyasu Y, Fujii W, Kano N. Comparison of the early results of transanal hemorrhoidal dearterialization and hemorrhoidectomy using an ultrasonic scalpel. Surg Today. 2015;45(2):175–80.  https://doi.org/10.1007/s00595-014-0885-5.CrossRefGoogle Scholar
  34. 34.
    Ratto C, Donisi L, Parello A, Litta F, Doglietto GB. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum. 2010;53(5):803–11.  https://doi.org/10.1007/DCR.0b013e3181cdafa7.CrossRefGoogle Scholar

Copyright information

© Springer Healthcare Ltd., part of Springer Nature 2019

Authors and Affiliations

  1. 1.National Hospital of Traditional MedicineHanoiVietnam
  2. 2.Hanoi Medical UniversityHanoiVietnam
  3. 3.OnCare Medical Technology Company LimitedHanoiVietnam

Personalised recommendations