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Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids
C Ratto1, P Giordano, L Donisi
1Department of Surgical Sciences, Catholic University, Rome, Italy. carloratto@tiscali.it
Techniques in Coloproctology
|April 21, 2011
Summary
Transanal haemorrhoidal dearterialization (THD) offers a safe and effective treatment for fourth-degree haemorrhoidal disease (HD). This minimally invasive procedure significantly improves symptoms for most patients, with minimal complications.
Area of Science:
- Colorectal Surgery
- Gastroenterology
- Minimally Invasive Procedures
Background:
- Conventional haemorrhoidectomy for fourth-degree haemorrhoidal disease (HD) often leads to significant pain and morbidity.
- Transanal haemorrhoidal dearterialization (THD) is an increasingly utilized technique for HD, aiming to reduce arterial blood flow.
- THD, incorporating rectal mucopexy, is now indicated for advanced HD stages, including fourth-degree.
Purpose of the Study:
- To evaluate the efficacy and safety of transanal haemorrhoidal dearterialization (THD) in treating fourth-degree haemorrhoidal disease (HD).
- To assess symptom improvement and complication rates associated with THD in patients with advanced HD.
Main Methods:
- Prospective enrollment of 35 patients with non-fibrotic fourth-degree HD.
- THD procedure with rectal mucopexy, with optional skin tag excision.
- Assessment using a validated HD severity score (0-20) pre- and post-procedure.
Main Results:
- Mean preoperative HD score was 18.1. Average operating time was 33 minutes.
- Postoperative complications included minor hemorrhoidal thrombosis, bleeding, and transient urinary retention in a small percentage of patients.
- At 10-month follow-up, 94% of patients showed significant symptom improvement, with a mean symptomatic score reduction to 2.5. No cases of anal stenosis or fecal incontinence were reported.
Conclusions:
- Transanal haemorrhoidal dearterialization (THD) is a safe and effective treatment option for fourth-degree haemorrhoidal disease (HD).
- The procedure provides significant symptom relief for the majority of patients, with most residual symptoms being transient and mild.
- Further research with larger cohorts and longer follow-up is recommended to solidify THD's role in managing this challenging patient group.
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