2012

Desarterialización hemorroidal transanal como tratamiento quirúrgico de la enfermedad hemorroidal: Reporte inicial


Morett R. S.
Cirujano General Vol. 34 Núm. 2 – 2012

OBJECTIVE:
To assess the results of transanal hemorrhoidal dearterialization (THD) as alternative surgical treatment to hemorrhoidal disease in 250 consecu- tive patients. Setting: Hospital Español (Third level Health Care Center).

DESIGN:
Descriptive, prospective, observational, and cross-sectional study. Statistical analysis: Percentages as summary measure for qualitative variables.

PATIENTS & METHODS:
The THD procedure was performed in 116 men and 134 women; it consisted in ligating the branches of the superior rectal artery, Doppler-guided, and adding mucosal pexis to correct the prolapse. Analyzed variables were: age, gender, Goligher’s hemorrhoidal grading, preoperative symptomatology, aggregated anal disease, surgical time for the THD alone or with an added procedure, postsurgical pain, in-hospital stay, complications, and satisfactoriness based on the analog visual scale (AVS), return to normal activities, recurrence of hemorrhoidal disease. All patients were followed for 1 year after surgery.

RESULTS:
Average age was of 42.8 years. According to Goligher’s classification, most patients, 140 (56%), corresponded to grade II, to grade III pertained 89 (36%), and grade IV with 21 (8%). Preoperative symptomatology included bleeding, prolapse, and pruritus in 101 (40%), only prolapse in 86 (34%), and bleeding in 63 (25%). Only 22 (8.8%) patients of the series coursed with acute inflammatory symptom. Aggregated diseases were: simple anal fistula in 11, deep fistula in 7, anal fissure in 19, symptomatic rectocele in 3. Average surgical time was of 28 min when performing THD alone, and of 35 min when adding a complementary anorectal procedure. Post- surgical pain according to AVS was 0-1 in 183 (73%), 2-3 in 47 (19%), 4-5 in 15 (6%), 6-7 in 5 (2%); 183 (73%) patients did not require analgesia. In-hospital stay below 24 hours in 183 (73%) patients and more than 24 hours in 67 (27%). The degree of satisfactoriness of the patient based on AVS was: 8-10 in 224 (89.6%), 6-7 in 12 (4.8), 4-5 in 9 (3.6%), and 1-3 in 5 (2%). Minor complications occurred in 22% of patients, recurrent prolapse and bleeding occurred in 13 (5.2%) patients; 220 (88%) returned to their daily activities in an average of 3 days.

CONCLUSION:
THD seems to be a valid method for the nonexcisional treatment of hemorrhoidal disease, being effective, safe, with a low incidence of complications.

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