Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids

Abstract

AimTransanal haemorrhoidal dearterialization (THD) has become well established for the treatment of haemorrhoids. In this study we describe a technical modification of this technique, targeted mucopexy (THD TM), and report the results for advanced haemorrhoids.MethodThe study included a prospective evaluation of patients with Grade IV (fourth-degree) haemorrhoids operated on with the THD TM technique. This consisted of an initial dearterialization when the haemorrhoidal arteries were transfixed and a second phase of mucopexy, using a different needle from that usually used in the original technique.ResultsFrom January 2007 to December 2011, 31 consecutive patients with Grade IV haemorrhoids were operated on using the THD TM technique. Postoperative pain was reported by 22 (70%) patients on day 1 and 19 (61%) on day 7, while nine (30%) did not experience any pain at all. Severe pain was reported by only nine (16%) patients. At a mean follow-up of 32 months, two (6.4%) patients required a further intervention for on-going symptoms.ConclusionTransanal haemorrhoidal dearterialization TM is effective for advanced haemorrhoids.What does this paper add to the literatureThis paper describes a technical modification of the original transanal haemorrhoidal dearterialization technique introduced by the senior author and reports the results achieved with it in patients with Grade IV haemorrhoids. We believe the modification has allowed a significant improvement in the outcome, especially when dealing with advanced haemorrhoids.

Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement

“…Reoperation, due to the recurrence of symptoms, was necessary in 2.7-22 % of patients (HAL: 2.7-22 %; THD: 4.1-17.8 %) [55,56].…”

Hemorrhoidal Disease, from Legacy to a Change of Perspective

“…Again, some authors are still debating if this is the correct approach, with new studies [29] and verifying the efficacy and feasibility of this relatively new surgical approach.…”

Doppler-guided hemorrhoidal artery ligation with hemorrhoidopexy: source and prevention of postoperative pain

“…However, I believe it is an option not necessary in case you run the mucopexy, as the transfixed point of closing the suture line may be given anyway, saving the total time of surgery. Finally, Giordano et al [12] in a series of 31 IV grades distinguishes the phase of arterial tying from that of execution of mucopexy for which he uses a second needle (4/8 with Vycril 2/0), addressing the areas of greatest incidence of prolapse, thus being able to limit mucopexy to a maximum of 4. By doing so, the severe pain in the postoperative day covered the 23 % of those who have complained about pain.…”

“…According to our data, the first consideration concerns the indication. Some papers extend the indication to the use of the THD with mucopexy technique also for IV grade [8,12,18] considering it safe and effective even in those cases. In our experience, the presence of severe pain was present in a statistically significant level in IV grades cases compared to III grades cases (p value 0.00333) and among those cases who had been subjected to a number of mucopexies greater than 4 (p value 0.034).…”

“…Although several surgical techniques have been proposed, we have not yet reached unanimous accordance about which technique is to be considered as the gold standard. In the last decade, several studies were published, starting from the first description of Moriaga in 1995, which [1] has taken into account the Doppler-guided hemorrhoidal artery ligation (DGHAL) technique, with or without hemorrhoidopexy, considering various aspects: the overall benchmarking with other techniques [2][3][4][5], the most appropriate indications [6][7][8], the satisfaction of patients [9], and the proposal to a number of changes of the technique [10][11][12]. The abovementioned reports have addressed and improved many aspects of the technique and, at the same time, have shown that this technique, in contrast to the initial enthusiasm, is not free from postoperative pain, rather that this is minimal only in cases in which the hemorrhoidopexy was applied.…”