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



The stapled hemorrhoidopexy (SH) and the Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) are minimally invasive procedures for the surgical treatment of hemorrhoids. This study aims to verify the efficacy of the DG-THD versus the SH in the treatment of third-degree hemorrhoids.


One hundred consecutive patients were causally allocated to either procedure, obtaining two groups of 50 pts. A clinical examination was performed at 3, 7, 15, and 30 days after the operation. Quality of life, anal symptoms, recurrence of hemorrhoids, and reoperation were assessed by means of a questionnaire and of a clinical examination at long-term follow-up (7.0 year average).


At short-term follow-up, the median postoperative pain score was significantly lower in DG-THD group compared to SH group, (V.A.S 2 vs 6; t = 2.65, p < 0.01). The morbidity rate and the return to normal life and work were similar after the two procedures. At long-term follow-up, the incidence of piles was not statistically different between the two groups (DG-THD 10.0 %; SH 14.0 %). No differences were reported by patients in terms of satisfaction for surgery.


SH and DG-THD procedures do not show significantly different results with regard to the patients outcome. However, considering the lower p. o. pain, the DG-THD might be proposed as the first line treatment in third-degree hemorrhoids.

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The authors thank Maria Silvia Marottoli for her assistance in the translation.

Statement of Author Contribution

S. Leardi: substantial contributions to the conception and design of the work, analysis and interpretation of data for the work

B. Pessia, M. Mascio, F. Piccione, M.: acquisition data for the work

M. Schietroma: drafting the work

R. Pietroletti: revising the work critically for important intellectual content

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Corresponding author

Correspondence to S. Leardi.

Additional information

R. Pietroletti from 2013 is the chief of the Colon-proctology Surgery Unit—Val Vibrata Hospital—Dept. of MeSVA, University of L’Aquila—Italy.



Questionnaire for patients who undergone surgery for third-degree hemorrhoids.


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Leardi, S., Pessia, B., Mascio, M. et al. 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 20, 1886–1890 (2016).

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  • Hemorrhoids
  • Stapled hemorrhoidopexy
  • DG-transanal hemorrhoidal dearterialization
  • Recurrence of hemorrhoids