Back
 SS  Vol.3 No.11 , November 2012
Doppler-Guided Transanal Haemorrhoidal Dearterialisation is a Safe and Effective Daycase Procedure for All Grades of Symptomatic Haemorrhoids
Abstract: Purpose: Doppler-guided transanal haemorrhoidal dearterialisation (THD), with the addition of rectal mucopexy, has been gaining popularity as a minimally invasive haemorrhoidal treatment. The aim of this study was to assess the outcomes of THD in patients with symptomatic haemorrhoids. Methods: All consecutive patients undergoing THD by a single surgeon over a 2 year period from 1st January 2010 were included. Results: THD was performed on 58 consecutive patients, with 46 (79.3%) having had previous haemorrhoidal treatment(s). Haemorrhoid grades were: 1 (n = 6); 2 (n = 12); 3 (n = 32); 4 (n = 8). The median number of THD ligations was 7 (range 4 to 9) and rectal mucopexies 3 (range 1 to 3). All procedures (100%) were carried out as daycase, with 1 readmission within 30 days (anal fissure). No patients required return to theatre. After median follow-up of 10.5 weeks (range 1 to 48 weeks, 2 lost to follow-up), 53 (91%) patients reported symptomatic resolution or significant improvement. Two (3.4%) patients had post-operative complications (anal fissure). Two (3.4%) patients had further haemorrhoidal surgery following THD. Conclusions: THD is a safe daycase procedure for symptomatic haemorrhoids of all grades. It is an effective treatment in the short term, but longer-term follow-up is required to assess its symptomatic benefit more formally.
Cite this paper: C. J. Deutsch, K. Chan, H. Alawattegama, J. Sturgess and R. J. Davies, "Doppler-Guided Transanal Haemorrhoidal Dearterialisation is a Safe and Effective Daycase Procedure for All Grades of Symptomatic Haemorrhoids," Surgical Science, Vol. 3 No. 11, 2012, pp. 542-545. doi: 10.4236/ss.2012.311107.
References

[1]   J. A. Marx, R. S. Hockberger, R. M. Walls, et al., Eds, “Rosen’s Emergency Medicine: Concepts and Clinical Practice,” 6th Edition, Elsevier, Philadelphia, 2006, pp. 1509-1512.

[2]   P. Giordano, P. Nastro, A. Davies and G. Gravante, “Prospective Evaluation of Stapled Haemorrhoidopexy versus Transanal Haemorrhoidal Dearterialisation for Stage II and III Haemorrhoids: Three-Year Outcomes,” Techniques in Coloproctology, Vol. 15, No. 1, 2011, pp. 67-73. doi:10.1007/s10151-010-0667-z

[3]   H. Ortiz, J. Marzo and P. Armendariz, “Randomized Clinical Trial of Stapled Haemorrhoidopexy versus Conventional Diathermy Haemorrhoidectomy,” British Journal of Surgery, Vol. 89, No. 11, 2002, pp. 1376-1381. doi:10.1046/j.1365-2168.2002.02237.x

[4]   N. Sohn, J. S. Aronoff, F. S. Cohen and M. A. Weinstein, “Transanal Hemorrhoidal Dearterialization Is an Alternative to Operative Hemorrhoidectomy,” The American Journal of Surgery, Vol. 182, No. 5, 2001, pp. 515-519. doi:10.1016/S0002-9610(01)00759-0

[5]   G. Felice, A. Privitera A, E. Ellul and M. Klaumann, “Doppler-Guided Hemorrhoidal Artery Ligation: An Alternative to Hemorrhoidectomy,” Diseases of the Colon & Rectum, Vol. 48, No. 11, 2005, pp. 2090-2093. doi:10.1007/s10350-005-0166-x

[6]   V. Shanmugam, M. A. Thaha, K. S. Rabindranath, K. L. Campbell, R. J. Steele and M. A. Loudon, “Rubber Band Ligation versus Excisional Haemorrhoidectomy for Haemorrhoids,” Cochrane Database of Systematic Reviews, Vol. 20, No. 3, 2005, pp. CD005034.

[7]   J. Burch, D. Epstein, A. B. Sari, H. Weatherly, D. Jayne, D. Fox and N. Woolacott, “Stapled Haemorrhoidopexy for the Treatment of Haemorrhoids: A Systematic Reviewk,” Colorectal Disease, Vol. 11, No. 3, 2009, pp. 233-243. doi:10.1111/j.1463-1318.2008.01638.x

[8]   J. L. Faucheron, D. Voirin and J. Abba, “Rectal Perforation with Life-Threatening Peritonitis Following Stapled Haemorrhoidopexy,” British Journal of Surgery, Vol. 99, No. 10, 2012, pp. 746-753. doi:10.1002/bjs.7833

[9]   C. Ratto, A. Parello, L. Donisi, F. Litta, G. Zaccone and G. B. Doglietto, “Assessment of Haemorrhoidal Artery Network Using Colour Duplex Imaging and Clinical Implications,” British Journal of Surgery, Vol. 99, No. 1, 2012, pp. 112-118. doi:10.1002/bjs.7700

[10]   P. Giordano, J. Overton, F. Madeddu, S. Zaman and G. Gravante, “Transanal Hemorrhoidal Dearterialization: A Systematic Review,” Diseases of the Colon & Rectum, Vol. 52, No. 9, 2009, pp. 1665-1671. doi:10.1007/DCR.0b013e3181af50f4

[11]   K. Morinaga, K. Hasuda and T. Ikeda, “A Novel Therapy for Internal Hemorrhoids: Ligation of the Hemorrhoidal Artery with a Newly Devised Instrument (Moricorn) in Conjunction with a Doppler Flowmeter,” The American Journal of Gastroenterology, Vol. 90, No. 4, 1995, pp. 610-613.

[12]   C. Ratto, L. Donisi, A. Parello, F. Litta and G. B. Doglietto, “Evaluation of Transanal Hemorrhoidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorrhoids,” Diseases of the Colon & Rectum, Vol. 53, No. 5, 2010, pp. 803-811. doi:10.1007/DCR.0b013e3181cdafa7

[13]   SPSS, SPSS version 16, SPSS Inc., Chicago, 2007.

[14]   P. Grigoropoulos, V. Kalles, I. Papapanagiotou, A. Mekras, A. Argyrou, K. Papgeorgiou and A. Derian, “Early and Late Complications of Stapled Haemorrhoidopexy: A 6-Year Experience from a Single Surgical Clinic,” Techniques in Coloproctology, Vol. 15, No. S1, 2011, pp. S79-S81. doi:10.1007/s10151-011-0739-8

[15]   M. J. Cheetham, N. J. Mortensen, P. O. Nystrom, M. A. Kamm and R. K. Phillips, “Persistent Pain and Faecal Urgency after Stapled Haemorrhoidectomy,” Lancet, Vol. 356, No. 9231, 2000, pp. 730-733. doi:10.1016/S0140-6736(00)02632-5

[16]   S. Cipriani and M. Pescatori, “Acute Rectal Obstruction after PPH Stapled Haemorrhoidectomy,” Colorectal Disease, Vol. 4, No. 5, 2002, pp. 367-370. doi:10.1046/j.1463-1318.2002.00409.x

[17]   J. E. Dowden, J. D. Stanley and R. A. Moore, “Obstructed Defecation after Stapled Hemorrhoidopexy: A Report of Four Cases,” The American Journal of Surgery, Vol. 76, No. 6, 2010, pp. 622-625.

[18]   A. Infantino, D. F. Altomare, C. Bottini, M. Bonanno, S. Mancini, T. Yalti, P. Giamundo, J. Hoch, A. El Gaddal and C. Pagano, “Prospective Randomized Multicentre Study Comparing Stapler Haemorrhoidopexy with Doppler-Guided Transanal Haemorrhoid Dearterialization for Third-Degree Haemorrhoids,” Colorectal Disease, Vol. 14, No. 2, 2012, pp. 205-211. doi:10.1111/j.1463-1318.2011.02628.x

[19]   A. Arezzo, V. Podzemny and M. Pescatori, “Surgical Management of Hemorrhoids. State of the Art,” Annali Italiani di Chirurgia, Vol. 82, No. 2, 2011, pp. 163-172.

[20]   I. Goulimaris, I. Kanellos, E. Christoforidis, I. Mantzoros, C. Odisseos and D. Betsis, “Stapled Haemorrhoidectomy Compared with Milligan-Morgan Excision for the Treatment of Prolapsing Haemorrhoids: A Prospective Study,” European Journal of Surgery, Vol. 168, No. 11, 2002, pp. 621-625. doi:10.1080/11024150201680009

[21]   M. S. Sajid, U. Parampalli, P. Whitehouse, P. Sains, M. R. McFall and M. K. Baig, “A Systematic Review Comparing Transanal Haemorrhoidal De-Arterialisation to Stapled Haemorrhoidopexy in the Management of Haemorrhoidal Disease,” Techniques in Coloproctology, Vol. 16, No. 1, 2012, pp. 1-8. doi:10.1007/s10151-011-0796-z

[22]   A. G. Acheson and J. H. Scholefield, “Management of Haemorrhoids,” British Medical Journal, Vol. 336, No. 7640, 2008, pp. 380-383. doi:10.1136/bmj.39465.674745.80

[23]   J. L. Faucheron, G. Poncet, D. Voirin, B. Badic and Y. Gangner, “Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal Repair (HAL-RAR) for the Treatment of Grade IV Hemorrhoids: Long-Term Results in 100 Consecutive Patients,” Diseases of the Colon & Rectum, Vol. 54, No. 2, 2011, pp. 226-231. doi:10.1007/DCR.0b013e318201d31c

[24]   S. Avital, R. Inbar, E. Karin and R. Greenberg, “Five-Year Follow-Up of Doppler-Guided Hemorrhoidal Artery Ligation,” Techniques in Coloproctology, Vol. 16, No. 1, 2012, pp. 61-65. doi:10.1007/s10151-011-0801-6

[25]   The HubBLe Trial: Haemorrhoidal Artery Ligation (HAL) versus Rubber Band Ligation (RBL) for haemorrhoids. http://www.controlled-trials.com/ISRCTN41394716/

 
 
Top