Transanal Haemorrhoidal Artery Echodoppler Ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study

Infantino A., Bellomo R., Dal Monte PP., Salafia C., Tagariello C., Ionizzo CA., Spazzafumo L., Romano G., Altomare DF.
Published Online 15 April 2009. Colorectal Dis. 2010 Aug; 12(8):804-9

We report a multicentric prospective study which aimed to evaluate Doppler-assisted ligation of the terminal haemorrhoidal arteries (THD) for II and III degree haemorrhoids.

112 patients from five colorectal units, including 81 males, mean age 48±13 years, with II degree (39) and III degree (73) haemorrhoids, were treated by Doppler-guided transanal de-arterialization and anopexy using a new device (THD).

The mean operative time was 33.9±8.8 minutes, and the mean number of ligatures applied was 7.2±1.5. Postoperatively 72% of patients did not need analgesics and the other 28% used non-steroidal anti-inflammatory drugs 1-3 times/day for less than 2 days. All the patients were operated as a day case. Early post-operative complications included haemorrhoidal thrombosis (2 patients), bleeding (1) treated by haemostatic suture, dysuria (6), and acute urinary retention (1). After a mean follow-up of 15.6±6.5 months (range 6-32), 2/105 (20.9%) patients complained of minor bleeding, while mild pain was still present in 4/51 (7.8%). There were no statistically significant differences in the sample population regarding gender or stage of the disease. Tenesmus was cured in 15/17, dyschaezia in 20/22 patients and mucous soiling in 10/10 patients. No new cases of altered defaecation or faecal incontinence were recorded. Overall 85.7% of patients were cured and 7.1% improved. Residual haemorrhoids were treated by elastic band ligation in 9 (8%) patients and by surgical excision in a further 5 (4.5%).

Doppler-assisted ligation of the terminal branches of the haemorrhoidal arteries for II and III degree haemorrhoids is highly effective and painless. Complications are few and the technique can be performed as a day case.