Skip to main content


Log in

Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: a retrospective study and literature review

  • Original Article
  • Published:
Techniques in Coloproctology Aims and scope Submit manuscript



The aim of this study was to evaluate and compare transanal haemorrhoidal dearterialisation (THD) and stapled haemorrhoidopexy [also called procedure for prolapsed haemorrhoids (PPH)] in the management of haemorrhoidal disease, in terms of short-term outcomes and efficacy.


Patients presenting with symptomatic haemorrhoids were treated with THD. Patient demographics, pre-operative data, post-operative pain scores, complications, recurrence, and patient satisfaction scores were evaluated and recorded. Patients with acute thrombosed haemorrhoids, external haemorrhoids only, or other concomitant anal diseases were excluded. These data were compared with the historical data of PPH.


Forty consecutive patients underwent THD from February 2012 to July 2013 and were compared to 37 patients who underwent PPH taken from a medical records database. There were no significant differences in terms of demographic data, type of anaesthesia, operative time, and blood loss. Length of hospital stay, time to first post-operative bowel movement, and complications were similar between the two groups. The median pain score after THD and PPH was 1.71 and 5.00, respectively, on a scale of 0–10 (10 = worst possible pain) (p = 0.000). There was a significant improvement in bleeding and prolapse scores after THD. THD patients had an earlier return to normal daily activities (3.13 vs. 6.78 days, p = 0.001) when compared with the PPH group. Upon follow-up, patients in both groups had similar satisfaction scores, and complication and recurrence rates.


Both THD and PPH appear to be safe procedures for haemorrhoidal disease, and they appear to have similar short-term outcomes. In particular, THD seems to be associated with a lower pain score than PPH, an earlier return to normal daily activities, and similar rates of complication and recurrence.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Johanson JF, Sonnemberg A (1990) The prevalence of hemorrhoids and chronic constipation. An epidemiological study. Gastroenterology 98:380–386

    PubMed  CAS  Google Scholar 

  2. Festen S, van Hoogstraten MJ, van Geloven AAW, Gerhards MF (2009) 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 24:1401–1405

    Article  PubMed  Google Scholar 

  3. Sajid MS, Parampalli U, Whitehouse P, Sains P, McFall MR, Baig MK (2012) A systemic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease. Tech Coloproctol 16:1–8

    Article  PubMed  CAS  Google Scholar 

  4. Wrobleski DE, Corman ML, Veidenheimer MC, Coller JAL (1980) Long-term evaluation of rubber ring ligation in hemorrhoidal disease. Dis Colon Rectum 23:478–482

    Article  PubMed  CAS  Google Scholar 

  5. Schulte T, Fändrich F, Kahlke V (2008) Life-threatening rectal necrosis after injection sclerotherapy for haemorrhoids. Int J Colorectal Dis 23:135–136

    Google Scholar 

  6. Tajana A, Chiurazzi D, De Lorenzi I (1995) Infrared photocoagulation, cryosurgery and laser surgery in hemorrhoidal disease. Ann Ital Chir 66:775–782

    PubMed  CAS  Google Scholar 

  7. MacRae HM, McLeod RS (1995) Comparison of hemorrhoid treatment modalities: a meta-analysis. Dis Colon Rectum 38:687–694

    Article  PubMed  CAS  Google Scholar 

  8. Chung CC, Cheung HYS, Chan ESW, Kwok SY, Li MKW (2005) Stapled hemorrhoidopexy vs Harmonic Scalpel™ hemorrhoidectomy: a randomized trial. Dis Colon Rectum 48:1213–1219

    Article  PubMed  CAS  Google Scholar 

  9. Ortiz H, Marzo J, Armendariz P (2002) Randomized clinical trial of stapled haemorrhoidopexy versus conventional diathermy haemorrhoidetomy. Br J Surg 89:1376–1381

    Article  PubMed  CAS  Google Scholar 

  10. Pescatori M, Favetta U, Dedola S, Orsini S (1997) Transanal stapled excision of rectal mucosal prolapse. Tech Coloproctol 1:96–98

    Google Scholar 

  11. Longo A (1998) Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. In: Proceedings of the 6th World Congress of Endoscopic Surgery, June 3–6, 1998, Rome, Italy

  12. Infantino A, Altomare DF, Bottini C, Bonanno M, Mancini S, the THD group of the SICCR (2011) Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis 14:205–213

    Article  Google Scholar 

  13. Gravié JF, Lehur PA, Huten N et al (2005) Stapled hemorrhoidopexy versus Milligan-Morgan hemorrhoidectomy: a prospective, randomized, multicenter trial with 2-year postoperative follow up. Ann Surg 242:29–35

    Article  PubMed  PubMed Central  Google Scholar 

  14. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal haemorrhoids: ligation of the hemorrhoidal artery with newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610–613

    PubMed  CAS  Google Scholar 

  15. Sohn N, Aronoff JS, Cohen FS, Weinstein MA (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182:515–519

    Article  PubMed  CAS  Google Scholar 

  16. Ratto C, Giordano P, Donisi L, Parello A, Litta F, Doglietto GB (2011) Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids. Tech Coloproctol 15:191–197

    Article  PubMed  CAS  Google Scholar 

  17. Giordano P, Nastro P, Davies A, Gravante G (2011) Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol 15:67–73

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  18. Shanmugam V, Watson AJM, Chapman AD, Binnie NR, Loudon MA (2005) Pathological audit of stapled haemorrhoidopexy. Colorectal Dis 7:172–175

    Article  PubMed  CAS  Google Scholar 

  19. Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V (2012) “Distal Doppler-guided dearterisalization” is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis 14:e786–e789

    Article  PubMed  CAS  Google Scholar 

  20. Lestar B, Penninckx F, Kerremans R (1989) The composition of anal basal pressure. An in vivo and in vitro study in man. Int J Colorectal Dis 4:118–122

    Article  PubMed  CAS  Google Scholar 

  21. Tjandra JJ, Chan MKY (2007) Systemic review on the procedure for prolapse and hemorrhoids (stapled hemorrhoidopexy). Dis Colon Rectum 50:878–892

    Article  PubMed  Google Scholar 

  22. Laughlan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G (2009) Stapled haemorrhoidopexy compared to Milligan-Morgan and Ferguson haemorrhoidectomy: a systemic review. Int J Colorectal 24:335–344

    Article  CAS  Google Scholar 

  23. Burch J, Epstein D, Baba-Akbari A et al (2009) Stapled haemorrhoidopexy for the treatment of haemorrhoids: a systemic review. Colorectal Dis 11:233–243

    Article  PubMed  CAS  Google Scholar 

  24. Chen JS, You JF (2010) Current status of surgical treatment for hemorrhoids: systemic review and meta-analysis. Chang Gung Med J 33:488–500

    PubMed  Google Scholar 

  25. Giordano P, Gravante G, Sorge R, Ovens L, Nastro P (2009) Long-term outcomes of stapled hemorrhoidopexy vs conventional hemorrhoidectomy: a meta-analysis of randomized controlled trials. Arch Surg 144:266–272

    Article  PubMed  Google Scholar 

  26. Ng KH, Ho KS, Ooi BS, Tang CL, Eu KW (2006) Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg 93:226–230

    Article  PubMed  Google Scholar 

  27. Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  28. Javaraman S, Colquboun PH, Malthane R (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305

    Article  Google Scholar 

  29. Bursics A, Morvay K, Kupcsulik P, Flautner L (2004) Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis 19:176–180

    Article  PubMed  Google Scholar 

  30. Zampieri N, Castellani R, Andreoli R, Geccherle A (2012) Long-term results and quality of life in patients treated with hemorrhoidectomy using two different techniques: ligasure versus transanal hemorrhoidal dearterialization. Am J Surg 104:684–688

    Article  Google Scholar 

  31. Elmér SE, Nygren JO, Lenander CE (2013) A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum 56:484–490

    Article  PubMed  Google Scholar 

  32. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52:1665–1671

    Article  PubMed  Google Scholar 

  33. Dal Monte PP, Tagariello C, Giordano P et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–339

    Article  PubMed  CAS  Google Scholar 

  34. Aigner F, Bodner G, Conrad F, Mbaka G, Kreczy A, Fritsch H (2004) The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal hemorrhoids. Am J Surg 187:102–108

    Article  PubMed  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Y. P. Tsang.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tsang, Y.P., Fok, K.L.B., Cheung, Y.S.H. et al. Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: a retrospective study and literature review. Tech Coloproctol 18, 1017–1022 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: