Techniques in Coloproctology

, Volume 22, Issue 3, pp 249–250 | Cite as

Reply to correspondence by Smart and Watson

  • C. Ratto
Author’s Reply

We appreciate the interest shown by Smart and Watson [1] in our article published in Techniques in Coloproctology [2]. 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 [2] 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.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

No informed consent was necessary for the study.


  1. 1.
    Smart NJ, Watson A (2017) A single-centre study on 1000 consecutive cases of transanal haemorrhoidal dearterialization. Tech Coloproctol. Google Scholar
  2. 2.
    Ratto C, Campennì P, Papeo F, Donisi L, Litta F, Parello A (2017) Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol 21(12):953–962CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Aigner F, Kronberger I, Oberwalder M et al (2016) Doppler-guided haemorrhoidal artery ligation with suture mucopexy compared with suture mucopexy alone for the treatment of Grade III haemorrhoids: a prospective randomized controlled trial. Colorectal Dis 18(7):710–716CrossRefPubMedGoogle Scholar
  4. 4.
    Lehur PA, Didnée AS, Faucheron JL et al (2016) Cost-effectiveness of new surgical treatments for hemorrhoidal disease: a multicenter randomized controlled trial comparing transanal Doppler-guided hemorrhoidal artery ligation with mucopexy and circular stapled hemorrhoidopexy. Ann Surg 264(5):710–716CrossRefPubMedGoogle Scholar
  5. 5.
    Brown SR, Tiernan JP, Watson AJM et al (2016) Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet 388(10042):356–364 (Erratum in: Lancet. 23;388(10042):342)Google Scholar
  6. 6.
    Ratto C (2017) Hemorrhoids and the recurrent attempts to destroy them. Tech Coloproctol 21(1):69–71CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Proctology Unit, University Hospital “A. Gemelli”Catholic UniversityRomeItaly

Personalised recommendations