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Doppler-guided transanal haemorrhoidal dearterialization (THD) for the treatment of symptomatic haemorrhoids: A cohort study

Sarhang Hussein Muhammed
Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq.
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Abstract

Background and objectives: Haemorrhoids is a common presenting problem to the surgical outpatient. Although open haemorrhoidectomy is an effective procedure, it can lead to significant postoperative pain, narrowing and incontinence. Among many alternative procedures with fewer complications, Transanal Haemorrhoidal dearterialization (THD) with mucopexyis an efficacious and safe alternative with less pain and complications. We aimed to evaluate the outcomes of THD, in terms of complications and recurrence rates, in the treatment of symptomatic haemorrhoids.

Methods: this prospective cohort study included all consecutive patients with symptomatic haemorrhoids who underwent THD and rectal mucopexy procedures between January 2013 and December 2022. Patients’ demographics, operative and postoperative data were recorded prospectively. Patients were seen at regular intervals for 60 months. Long-term complications, recurrence and reoperation were recorded during the visits. Microsoft® Excel 2020 and SPSS

version 26 was used for data entry and analysis.

Results: Eighty-six consecutive patients presented with symptomatic haemorrhoids and underwent THD. The mean age was 41 years, and 80% were men. Rectal bleeding was the most common presenting symptom in 61%, followed by pain and prolapse in 15% and 16%, respectively. Eight per cent of patients presented with strangulated haemorrhoids. Grade III haemorrhoids was the commonest (46.5%). Mean operation time was <30 minutes in 65% of cases. Minor bleeding for 2 days was noticed in 43% of cases after surgery, and minor pain for 3-4 days in 45.3%. Recurrence was noted in 5.8% of cases. The reoperation rate was 2.3%.

Conclusion: Data suggest that THD is safe and effective in treating symptomatic haemorrhoids, with low recurrence and reoperation rates.

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References

  1. Khudhur MSF, Al Dabbagh A. Colonoscopic findings in patients with bleeding per-rectum in colonoscopy center at Rizgary Teaching Hospital, Erbil, Iraq. Anb Med J. 2023; 19(1):42-7. https://doi.org/10.33091/amj.2023.178354
  2. Al-Ubaide AF, Al-Ani RM. Bleeding per rectum: A retrospective study of 120 cases. KCMJ. 2024; 20(1):32-6. https://doi.org/10.47723/y9neg550
  3. Medina-Gallardo A, Curbelo-Pe~na Y, De Castro X, Roura-Poch P, Roca-Closa J, De Caralt-Mestres E. Is the severe pain after Milligan-Morgan haemorrhoidectomy still Currently remaining a major postoperative problem despite being one of the oldest surgical Techniques described? A case series of 117 consecutive patients. Int J Surg Case Rep. 2016; 30:73e5. https://doi.org/10.1016/j.ijscr.2016.11.018
  4. Maeda Y, Phillips RKS. Open haemorrhoidectomy. In: Khubchandani I, Paonessa N, Khawaja A (eds) Surgical treatment of haemorrhoids. London, Springer, 2009, 71-7.
  5. Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal haemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol. 1995; 90:610–3.
  6. Sohn N, Aronoff JS, CohenFS,Weinstein MA. Transanal hemorrhoidal dearterialization is an alternative to operative haemorrhoidectomy. Am J Surg. 2001; 182:515–9. https://doi.org/10.1016/S0002-9610(01)00759-0
  7. Dal Monte PP, Tagariello C, Sarago M, Giordano P, Cudazzo E, Shafi A, et al. Transanal Haemorrhoidal Dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol. 2007; 11:333-8. https://doi.org/10.1007/s10151-007-0376-4
  8. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G. Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum. 2009; 52:1665-71. https://doi.org/10.1007/DCR.0b013e3181af50f4
  9. Sobrado CW, Klajner S, Hora JAB, da Silva FML, and Frugis MO. Transanal Haemorrhoidal Dearterialization with mucopexy (THD-M) for treatment of haemorrhoids: Is it applicable in all grades? Brazilian multicenter study. ABCD Arq Bras Cir Dig. 2020; 33(2):e1504. https://doi.org/10.1590/0102-672020190001e1504
  10. Aigner F, Bodner G, Conrad F, Mbaka G, Kreczy A, Fritch H. The superior rectal artery and its branching pattern with regard to its clinical influence on ligation techniques for internal haemorrhoids. Am J Surg. 2004; 187:102–8. https://doi.org/10.1016/j.amjsurg.2002.11.003
  11. Ratto C, Donisi L, Parello A, Litta F, Doglietto GB. Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to haemorrhoids. Dis Colon Rectum. 210; 53:803–81. https://doi.org/10.1007/DCR.0b013e3181cdafa7
  12. Ratto C. THD Doppler procedure for haemorrhoids: the surgical technique. Tech Coloproctol. 2014; 18:291-8. https://doi.org/10.1007/s10151-013-1062-3
  13. Ratto C, de Parades V. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: a technique for the future. J Visc Surg. 2015; 152(2 Suppl):S15–S21. https://doi.org/10.1016/j.jviscsurg.2014.08.003
  14. Infantino A, Bellomo R, Dal Monte PP, et al. Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study. Colorectal Dis. 2010; 12:804-9. https://doi.org/10.1111/j.1463-1318.2009
  15. Ratto C, Campenni P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017; 21:953-62. https://doi.org/10.1007/s10151-017-1726-5
  16. Loganathan A, Das A, Luck A, Hewett P. Transanal haemorrhoidal dearterialization for the treatment of grade III and IV haemorrhoids: a 3-year experience. ANZ J Surg. 2016; 86:59-62. https://doi.org/10.1111/ans.12816
  17. Patel R, Rehman A, Baig M, Ali Kazem M, Khan A. A cohort study analysing outcomes following Transanal Haemorrhoidal Dearterialisation (THD). The Surgeon. 2021; 19:72-6. https://doi.org/10.1016/j.surge.2020.02.008
  18. Ratto C, Giordano P, Donisi L, Parello A, Litta F, Doglietto GB. Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids. Tech Coloproctol. 2011; 15:191-7. https://doi.org/10.1007/s10151-011-0689-1
  19. Cavazzoni E, Bugiantella W, Graziosi L, Franceschini S, Cantarella F, Rosati E, et al. Emergency Transanal haemorrhoidal doppler guided dearterialization for acute and persistent haemorrhoidal bleeding. Colorectal Disease. 2012; 15:e89-e92. https://doi.org/10.1111/codi.12053
  20. Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S. Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis. 2014; 16:373-6. https://doi.org/10.1111/codi.12574
How to Cite
Muhammed, S. H. (2025). Doppler-guided transanal haemorrhoidal dearterialization (THD) for the treatment of symptomatic haemorrhoids: A cohort study. Zanco Journal of Medical Sciences (Zanco J Med Sci), 29(3), 582–589. https://doi.org/10.15218/zjms.2025.063

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