2004

Doppler-guided transanal haemorrhoidal dearterialisation is an effective technique for the treatment of symptomatic haemorrhoids


Dal Monte PP., Tagariello C., Saragò M., Giordano P.
British Journal of Surgery. 2004 May; 91 (1): 70

AIMS:
To assess the efficacy and safety of Doppler-guided transanal haemorrhoidal dearterialisation (THD) for the treatment of haemorrhoids

METHODS:
Patients with second- and third-degree haemorrhoids who had failed to respond to conservative treatment and/ or sclerotherapy were offered THD. The procedure was performed using a specifically designed proctoscope. The proctoscope has on its right side a small channel for the insertion of a fine Doppler probe there is a small window to allow suturing of the rectal mucosa 2-3 cm above the dentate line. The Doppler probe was used to locate all the terminal branches of the haemorrhoidal arteries, which were then sutured. Patients were followed up at 1 week, 2 months and every 6 months thereafter.

RESULTS:
From January 200 to September 2003, 130 patients (61 female, mean age 53 years) underwent this procedure and were followed up for a minimum of 2 months (mean follow-up 38 months). All patients returned to work within 3 days. In 121 (93%) patients the operation resolved the symptoms. In the nine patients with failure repeat Doppler showed at least one residual artery. Six of these nine patients underwent further THD, which was successful in all cases. There were seven postoperative complications (two PR bleeds, three thrombosed piles, one submucosal rectal haematoma and one urinary retention). One postoperative bleeding required re-intervention.

CONCLUSION:
THD is a safe and effective procedure. With minimal postoperative pain and quick recovery THD has the potential to become the treatment of choice for second and third-degree haemorrhoids.

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