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Hemorrhoids pp 415-447 | Cite as

Literature Review on Dearterialization of Hemorrhoids and Mucopexy

  • Mark Lienert
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)

Abstract

Introduction

This chapter gives a revision of the literature on dearterialization of hemorrhoids combined with mucopexy for treatment of hemorrhoidal disease, in order to present its evolution, safety, and efficacy of the technique, to define its indications, as well as to show advantages, disadvantages, and modalities of surgical treatment.

Methods

Performing a literature search in PubMed, Livivo, and Cochrane, one has to use multiple terms, including different combinations and variations of “transanal hemorrhoidal dearterialization (THD),” “Doppler-guided hemorrhoidal artery ligation (DGHAL),” “dearterialization of hemorrhoids,” “mucopexy,” “anopexy,” “suture mucosal pexy,” and “recto anal repair.”

In addition, references of selected articles were looked on to find more studies in this field.

Included were articles available in English or German.

Results

An overall of 51 articles including 5315 patients were identified concerning dearterialization of hemorrhoids combined with mucopexy, beginning in the year 2007 up to today.

The overall quality was poor with recurrence rates ranging between 0% and 40%, highest in patients with fourth degree hemorrhoidal disease. The overall complication rate was low, nearly all minor complications, without life threatening or deadly complications.

One to 16 ligations were performed with a number of pexies from one up to nine.

Reintervention rates were stated between cero and 29%.

Operation times differ from 10 min up to 1 h.

The overall patient satisfaction, as far as specified, was 75% up to 99%, mainly around 90%.

Conclusion

Doppler-guided hemorrhoid artery ligation combined with mucopexy is safe and especially in second and third degree hemorrhoidal disease efficacious, with a moderate complication rate and the absence of life-threatening incidents.

The learning curve seems to be flatter than expected with acceptable recurrence rates in experienced hands. The question whether Doppler guidance is needed or not cannot be answered with absolute certainty so far.

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Wedau KlinikenSana Kliniken Duisburg GmbHDuisburgGermany

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