THD Doppler procedure decreases haemorrhoidal artery hyperflow

De Simone V., Parello A., Donisi L., Litta F. et al.
Colorectal Disease 2013, 15 (Suppl. 3), 48-116, Poster 316 from ESCP Meeting 2013 in Belgrade

THD Doppler procedure provides haemorrhoidal dearterialization in six sectors of low rectum, to reduce arterial hyperflow. How Doppler-guided arteries ligations could influence hemorrhoidal blood flow is unknown.

Seventeen III-degree haemorrhoids patients underwent THD Doppler procedure. Before and 12 months after surgery, they were submitted to endoanal ultrasound and colour duplex imaging. Arteries within internal piles were sampled, and peak systolic (PS), acceleration time (AT), end diastole (ED), resistivity index (RI), and pulsatility index (PI) were evaluated. Pre-op and post-op data were compared.

THD Doppler was successful in treating bleeding in all patients and prolapse in all but one. Significant reduction of values was demonstrated for: PS (from 18.7 ± 1.1 to 10.3 ± 0.4 cm/s, P < 0.05), RI (from 1.0 ± 0.2 to 0.8 ± 0.5, P < 0.05), and PI (from 5.5 ± 0.3 to 2.8 ± 0.4, P < 0.05). Mean ED variation was statistically not significant (from 1.9 ± 0.2 to 2.0 ± 0.4 cm/s, P = 0.753), while mean AT was significantly increased (from 65.6 ± 3.6 to 83.3 ± 4.7 cm/s2, P < 0.05)

Artery ligation modifies significantly haemorrhoidal hemodynamic. Reduction of post-op blood flow incoming to piles is demonstrated by decrease at PS and entire cardiac cycle (PI and RI). Successful arteries decongestion, after THD Doppler, results in prolonged AT. Diastolic flow velocity (ED) did not undergo significant variations.