Postoperative results of 407 patients submitted to Doppler-guided transanal hemorrhoidal dearterialization

Abstract

Introduction The treatment of hemorrhoidal disease by conventional technique is associated with significant morbidity, mainly represented by the postoperative pain and the late return to daily activities. A technique of hemorrhoidal dearterialization associated with rectal mucopexy is a minimal invasive surgical option that has been used to treat the hemorrhoidal disease and reduce its inconveniences. Objective To analyze the seven-year results of hemorrhoidal dearterialization associated with rectal mucopexy in the treatment of hemorrhoidal disease. Methods This study analyzed 407 patients with hemorrhoids grade II, III and IV, who underwent the technique of hemorrhoidal dearterialization in the Luzia de Pinho Melo Hospital, during the period between December 2010 and December 2017. Twenty-seven patients (6.6%) had hemorrhoidal disease of the grade II, 240 (59.0%) grade III, and 117 (28.8%) grade IV. In 23 patients (5.7%), the grade was not found. All patients were operated by the same surgeon under spinal anesthesia. The 407 patients underwent dearterialization, with a varying ligation of one to six arterial branches followed by rectal mucopexy by uninterrupted suture. Eighty-two (20.14%) required removal of concomitant perianal piles or external hemorrhoids and/or fibrosed. In the postoperative follow-up the following parameters were evaluated: pain, tenesmus, bleeding, prolapse, thrombosis, and recurrence. Results The tenesmus was postoperative complaint reported by 93.6% of patients. Forty-three (10.5%) presented intense tenesmus and 44 (22%), moderate to intense pain. Four (0.98%) patients presented more intense bleeding in postoperative follow up; none of the patients required blood transfusions. The prolapse occurred in 18 (4.42%) patients, thrombosis in 11 (2.7%), and there were 19 (4.67%) recurrences that were reoperated in this period. Conclusion The hemorrhoidal dearterialization technique presents good results, with light and easy-to-resolve complications and little postoperative pain.

Selective Hemorrhoidal Dearterialization with High Mucopexy in the Surgical Treatment of Hemorrhoidal Disease

“…We ourselves, evaluating 407 patients with HD grades II (6.6%), III (59%) and IV (28.8%) submitted to DGHD þ M, found that tenesmus was the main complaint, reported by 93.36% of the patients. 12 In 43 (10.5%) of the 379,98 patients presented intense tenesmo and 44 (10.81%%) patients presented from moderate to intense tenesmo, 4 patients had major postoperative bleeding, and 1 (0.5%) of them required revision of hemostasis and blood replacement. In the postoperative follow-up, 18 (4.42%) patients evolved with prolapse, 11 (2.7%) with thrombosis of !…”

“…Although we have been familiar with the classical technique of DGHD þ M since 2010, selective hemorrhoidal hight lifting (SHeLF) was conceived based on the need to propose a new technical option that reduced the high rates of tenesmus, as well as anal pain and bleeding that present a worrying incidence after the classical technique. 12 We believe that the reduction of these indexes could perhaps be achieved if we performed high mucopexy only in the cushions where there is significant arterial flow, which increases the volume of the hemorrhoidal cushion and, consequently, the prolapse. Therefore, this new technical option could confer a greater selectivity to the treatment.…”

“…This technique is a noninvasive surgical option, as it is not excisional, and has been used to treat the various degrees of HD. 1,12 In the DGHD þ M technique, six arterial branches identified by Doppler are dearterialized throughout the circumference of the mucosa of the distal rehest, and mucopexy is performed by means of a manual suture that begins in the highest portion of the cushion and ends just above the pectinline line. 1,12 The ligation of six arterial branches made the surgery more laborious.…”

“…1,12 In the DGHD þ M technique, six arterial branches identified by Doppler are dearterialized throughout the circumference of the mucosa of the distal rehest, and mucopexy is performed by means of a manual suture that begins in the highest portion of the cushion and ends just above the pectinline line. 1,12 The ligation of six arterial branches made the surgery more laborious. With this, in many cases, dearterialization was performed in a place where, although a prolapsed hemorrhoidal cushion was not identified, it was possible to identify arterial blood flow.…”

Hybrid Vs Pure Hemorrhoidal Artery Ligation for the Treatment of Hemorrhoids: A Retrospective Study

“…1 Hemorrhoids are thought to affect up to half of the population. [1][2][3] Hemorrhoids are naturally occurring swellings of the submucosal veins of the anal canal. They serve as anal cushions.…”