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Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease

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Techniques in Coloproctology Aims and scope Submit manuscript

As is in life... In their quest for the truth, men make two steps ahead and one behind. Suffering, errors and boredom push them backwards, but thirst for the truth and obstinate will, pushes them forwards. And who knows? Perhaps they will find the truth.

Anton Checov

Abstract

Background

Transanal haemorrhoidal dearterialisation (THD) is a nonexcisional surgical technique for the treatment of piles, consisting in the ligation of the distal branches of the superior rectal artery, resulting in a reduction of blood flow and decongestion of the haemorrhoidal plexus. The aim of this study was to assess the long-term efficacy of this treatment.

Methods

The procedure was carried out using a proctoscope with a Doppler probe. The terminal branches were located with Doppler and then sutured.

Results

From January 2000 to May 2006, we performed THD in 330 patients (180 men; mean age, 52.4 years), including 138 second-degree, 162 third-degree and 30 fourth-degree haemorrhoids. There were 23 postoperative complications (7 cases of bleeding, 5 thrombosed piles, 4 rectal haematomas, 2 anal fissures, 2 cases of dysuria, 1 of haematuria and 2 needle ruptures). The mean postoperative pain score was 1.32 on a visual analog scale. 219 patients were followed for a mean of 46 months (range, 22–79), including 100 patients with second-degree, 104 with third-degree and 15 with fourth-degree haemorrhoids. The operation completely resolved the symptoms in 132 patients (92.5%) with preoperative bleeding and in 110 patients (92%) with preoperative prolapse.

Conclusions

The efficacy and relapse rate of this procedure appears to be similar to that of traditional surgery and stapled haemorrhoidopexy. The technique was effective and safe for all degrees of haemorrhoids because of the excellent results, low complication rate and minor postoperative pain.

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Authors and Affiliations

  1. Casa di Cura Villalba, Via Roncrio 25, Bologna, Italy

    P. P. Dal Monte

  2. Casa di Cura M.F. Toniolo, Bologna, Italy

    P. P. Dal Monte, C. Tagariello & M. Sarago

  3. Whipps Cross University Hospital, London, UK

    P. Giordano & A. Shafi

  4. Civil Hospital, Guastalla (RE), Italy

    E. Cudazzo & M. Franzini

  5. St. Mark’s Hospital, Harrow, UK

    R. K. S. Phillips

Authors
  1. P. P. Dal Monte
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  2. C. Tagariello
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  3. P. Giordano
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  4. E. Cudazzo
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  5. A. Shafi
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  6. M. Sarago
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  8. R. K. S. Phillips
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Correspondence to P. P. Dal Monte.

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Dal Monte, P.P., Tagariello, C., Giordano, P. et al. Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11, 333–339 (2007). https://doi.org/10.1007/s10151-007-0376-4

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  • DOI: https://doi.org/10.1007/s10151-007-0376-4

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