Reply to correspondence by Smart and Watson
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We appreciate the interest shown by Smart and Watson  in our article published in Techniques in Coloproctology . Their remarks open a complex debate on the “applicability” of a new specialist technique to the “average” colorectal surgeon. The authors of the letter are skeptical about the ability of the average colorectal specialist to perform an operation for hemorrhoidal disease [e.g., transanal hemorrhoidal dearterialization (THD)] with less than a 10% recurrence rate in the medium term. Our 9.5% recurrence rate at 44 ± 29 months mean follow-up should be considered as a realistic percentage of failure when applied to a patient population such as the one in our study. We have been transparent in our patient selection process and treatment algorithms in our study published in Techniques in Coloproctology  and more so than many centers that either perform only THD or that perform rubber band ligation (RBL) as a first intervention. Whatever the amount of specialization within...
Compliance with ethical standards
Conflict of interest
Carlo Ratto was, for 1 year, member of the THD Advisory Board; no personal salary was received.
This article does not contain any studies with human participants or animals performed by any of the authors.
No informed consent was necessary for the study.
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