Doppler-guided hemorrhoidal dearterialization transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years

Marleny Novaes Figueiredo, Guilherme Campos F.
World J Gastrointest Surg 2016 March 27; 8(3): 232-237

In the setting of Hemorrhoidal Disease treatment, the option of conventional hemorrhoidectomy is highly effective, but it is still associated with postoperative pain and discomfort. For this reason, technical alternatives have been developed in order to reduce complications and to provide better postoperative recovery. To accomplish this aim, non-excisional techniques such as stapled hemorrhoidectomy and Doppler-guided hemorrhoidal ligation have been introduced into clinical practice with high expectations. The aim of this article is to revise the literature about transanal hemorrhoidal dearterialization technique in the treatment of hemorrhoidal disease, looking into its evolution, results and possible benefits over other modalities of surgical treatment. The literature review showed that Doppler guided hemorrhoidal dearterialization is a safe and effective method to treat grades II to IV hemorrhoidal disease. Outcomes in patients presenting prolapse are satisfactory and the association of anopexy is an important aspect of this operation. Anal physiology disturbances are rarely observed and mainly transitory. This technique is an excellent option for every patient, especially in those with previous anal surgeries and in patients with previous alterations of fecal continence, when an additional procedure might represent a risk of definitive incontinence.

Management of hemorrhoidal disease is a tough task. First of all, because there are some technical alternatives that should be adequately indicated to different patients; secondly, because patients desire a good alternative associated with low morbidity, good long-term results and less postoperative pain. In this setting, the transanal hemorrhoidal dearterialization (THD) technique is considered a safe and effective choice for internal hemorrhoids of grades II to IV. The present paper reviews technical aspects and literature results of THD in comparison to other operative techniques.