Evaluation of Transanal Hemorrhoidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorrhoids

Ratto, Carlo; Donisi, Lorenza; Parello, Angelo; Litta, Francesco; Doglietto, Giovanni Battista

doi:10.1007/dcr.0b013e3181cdafa7

Cited by 108 publications

(94 citation statements)

References 14 publications

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“…In 2011, a French group, in an uncontrolled study with 100 patients with grade IV hemorrhoids, obtained good results with median follow-up of 34 months 16. In the same year, Ratto et al published the results of the procedure in 35 consecutive patients with more advanced hemorrhoidal disease, obtaining similar data 29 , which suggests that the technique has potential use for the majority of cases with surgical indication 28,29,30,33 . Since then, initial experiments in several countries 5,13,25,27,34 , have been published, with good results, the procedure being isolated or associated with other techniques.…”

Section: Discussionmentioning

confidence: 86%

“…Recent studies 28 , with endoanal ultrasound Doppler (360° -rotating ltrasonographic endoprobe) demonstrated that in the circumference of the wall of the distal rectum, 6 cm above the anal verge, is generally identified six arterial branches located in positions 1, 3, 5, 7, 9 and 11 hours in individuals with or without hemorrhoids. In the same study showed that in patients with hemorrhoidal disease, there is increased arterial blood flow velocity and decrease in venous resistance.…”

Section: Anatomophysiological Bases Of the Techniquementioning

confidence: 99%

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Desarterialização transanal guiada por doppler associada ao reparo anorretal na doença hemorroidária: a técnica do THD

Sobrado

Hora

2012

ABCD, arq. bras. cir. dig.

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-Introduction -Surgical treatment for hemorrhoids should be indicated individually and is based on the predominant symptom (bleeding or prolapse), severity of disease and the presence or absence of external component (plicoma). Surgeons must choose among varied techniques the one suitable for each case. Technic -The THD procedure consists of Doppler guided high ligation, selective to up six submucosal arterial branches that supply the hemorrhoids, leading to its desarterialization associated with prolapse repair (anorectal repair or lifting). It uses special equipment and kit. Conclusion -THD technique has shown good initial results. Because surgical technique respects the anatomy, it acts directly on the pathophysiology of the disease and corrects its principal consequences; it looks quite promising. Its initial application may be in patients with hemorrhoids grade II, which have surgical indication, grades III and IV, the latter being associated with resection of plicomas. ABCDDV/887RESUMO -Introdução -O tratamento cirúrgico para hemorroidas deve ter indicação individual e baseia-se no sintoma predominante (sangramento ou prolapso), na gravidade da doença e na presença ou ausência de componente externo (plicoma). Cabe ao cirurgião conhecer as mais variadas técnicas para que possa encontrar o tratamento mais adequado caso a caso. Técnica -O procedimento THD consiste na ligadura alta seletiva e guiada por Doppler de até seis ramos arteriais submucosos que irrigam as hemorroidas, levando à sua desarterialização, associada à correção do prolapso (reparo anorretal ou lifting). Utiliza equipamento e kit especiais. Conclusão -A técnica do THD tem mostrado bons resultados iniciais. Por ser técnica cirúrgica em que se respeita a anatomia, ela age diretamente sobre a fisiopatologia da afecção e corrige suas principais consequências, ela parece bastante promissora. Sua aplicação inicial pode ser nos pacientes com doença hemorroidária de II grau, que tenham indicação de tratamento cirúrgico, e de III e IV graus, nestes últimos, podendo ser associada à ressecção de plicomas.

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Section: Discussionmentioning

confidence: 86%

Section: Anatomophysiological Bases Of the Techniquementioning

confidence: 99%

Desarterialização transanal guiada por doppler associada ao reparo anorretal na doença hemorroidária: a técnica do THD

Sobrado

Hora

2012

ABCD, arq. bras. cir. dig.

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“…The THD system uses a transanal approach to reach the distal third of the rectum, where, in fourth-degree HD, combined dearterialization and mucopexy are performed [9]. Dearterialization should reduce the arterial overflow to the haemorrhoids and then control bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…As originally described, this procedure aims to decrease the arterial blood flow to the haemorrhoids [7,8]. More recently, though a rectal mucopexy specifically introduced to address the prolapsing component has become part of the THD technique, so that the procedure is indicated for more advanced degrees of HD [9]. However, the safety and effectiveness of THD for the most advanced stages of HD remain unclear.…”

Section: Introductionmentioning

confidence: 99%

Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids

et al. 2011

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Transanal haemorrhoidal dearterialization seems to be a safe and effective treatment for fourth-degree HD providing a significant improvement of symptoms for the majority of patients. When present, persisting symptoms are mostly transient, occasional or limited in severity, and only a very few patients require further intervention. Larger series and longer follow-up to further assess the role of THD in this challenging group of pts.

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“…The complex vascular network of the ''corpus cavernosum recti'' is the key to perfecting this therapeutic approach. According to our experience, there are always more than three (usually six) terminal branches of hemorrhoidal arteries to be ligated [2]. The target of therapy should be the point at which the arteries enter the submucosa of the low rectum, just before supplying blood to the ''corpus cavernosum recti'' [3].…”

mentioning

confidence: 99%

To improve the “target” of transanal hemorrhoidal dearterialization

Ratto

Parello

2011

Tech Coloproctol

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Evaluation of Transanal Hemorrhoidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorrhoids

Cited by 108 publications

References 14 publications

Desarterialização transanal guiada por doppler associada ao reparo anorretal na doença hemorroidária: a técnica do THD

Desarterialização transanal guiada por doppler associada ao reparo anorretal na doença hemorroidária: a técnica do THD

Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids

To improve the “target” of transanal hemorrhoidal dearterialization

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