THD Doppler Method for hemorrhoid surgery

THD® Doppler Method

  • THD® Doppler: indications
  • THD® Doppler: Surgical procedure
  • Outcomes and benefits
  • Endorsements

THD® Doppler: indications

According to clinical evidence and comprehensive scientific literature reviews, THD® Doppler Procedure is indicated for the surgical treatment of all degrees of hemorrhoids.1,2,3

The procedure has proven to be effective and safe for all degrees of hemorrhoids, including grades that do not respond to conservative and outpatient treatments. Based on the symptoms and on the disease grade, the surgeon can decide whether to perform arterial hemorrhoidal ligation only or dearterialization with mucopexy.


  1. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature, Ratto C. et al, Tech Coloproct. (2017) 21: 953-962.
  2. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes, Trenti L., Biondo S. et al, Tech Coloproctol. 2017 May.
  3. Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial, Denoya P. et al, Tech Coloproct (2014) 18: 1081-1085.

THD® Doppler: surgical procedure

THD® Doppler Method is the result of a significant experience in operating rooms, cutting-edge technological advances, and constant medical research. THD® Doppler surgery manages both causes and symptoms of hemorrhoidal disease effectively.

THD® Doppler is a two-step procedure that handles both blood overflow and hemorrhoidal prolapse. Hemorrhoidal disease is associated with hemorrhoids hypertension (vascular component) and connective tissue degeneration (mechanical component). Both the vascular and the mechanical components are connected with hemorrhoidal symptoms like bleeding, pain, and prolapse.

THD's goal is acting on the pathophysiology of the disease and correcting its main consequences. That is why the THD® Doppler Method includes both hemorrhoidal dearterialization and mucopexy.

Dearterialization reduces arterial hyperflow to hemorrhoids through the ligation of terminal branches of the rectal artery under the guide of a Doppler ultrasonography. While the aim of mucopexy is to reposition prolapsed tissue into its anatomical position, as well as to provide support for degenerated tissue.

Surgical procedure


During the procedure, the surgeon fully inserts the anoscope by gently dilating the anus with the help of a clamp.

The surgeon then retracts and moves the anoscope distally to identify the maximum doppler signal, just above the anorectal junction.

The area where the signal is greatest is close to the internal hemorrhoidal plexus: within this area, there is a point where the signal is stronger, due to the fact that the artery is closer to the surface and so the blood flow is more conspicuous. This point is therefore the best target for effectively reducing the hyperemia by dearterialization. Using electrocautery or of a surgical marking pen, the surgeon then marks this point (Marker point).

The surgeon reinserts the anoscope completely and places a fixation stitch as an anchoring point (Figure 8 knot).

Afterward, the surgeon pulls back the sliding part of the anoscope to perform a running stitch until the marker point inclusion, staying 1-2 cm proximal to the anorectal junction.

The dearterialization procedure is performed in an area without nerve endings, thus considerably reducing pain, one of the main complications associated with traditional hemorrhoidectomy.

Upon closing the knot, the prolapsed tissue is lifted inside restoring the anatomical condition. The scarring process induced by mucopexy helps to stabilize and affix the tissues to the underlying rectal muscle.

The surgeon gently extracts the Doppler protecting the mucopexy and repeats the procedure moving clockwise.

THD® Revolution Doppler generator with built-in LED light source and the dedicated anoscope THD® Slide are specifically designed to perform the procedure.

The procedure is normally performed in a day surgery setting and the patient is normally discharged 8 hours after surgery.

The mean operative time is approximately 30 minutes1 and the patient can typically return to normal activities in 2-3 days on an average.2

To find out more about the steps of THD® Doppler procedure and how it is performed, download THD® Doppler brochure.


  1. Evaluation of Transanal Hemorroidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorroids, C. Ratto et al., Dis Colon Rectum 2010; 53 (5): 803-811.
  2. Dearterializzazione emorroidaria transanale doppler guidata, C. Tagariello et al., Casa di Cura M. F. Toniolo, Villa Erbosa, Bologna, Chirurgia Italiana 2004; Vol. 56 (5): 693-697.

Outcomes and Benefits

THD® Doppler Procedure has changed the surgical approach to hemorrhoids treatment, maximizing the effectiveness of results while reducing discomfort, invasiveness and pain for the patient.

THD® Doppler method offers durable results in grade II, III and IV hemorrhoids with advantages and benefits for both the physician and the patient:

  • Minimally invasive procedure: non-excisional, preserves the anorectal physiology and the vital function of hemorrhoids. Furthermore, it is performed in an area free from nerve endings. All these aspects result in shorter recovery times, quick return to normal activities, minor post-operative pain and minor post-operative bleeding
  • wide indications: the procedure is indicated for all hemorrhoid grades and has proven to be effective on prolapse and thrombosed hemorrhoids
  • low recurrence rate: unlike most outpatient procedures, it has a low recurrence rate.
  • repeatable: unlike excisional hemorrhoid surgery, it can be performed multiple times, as needed
  • no major complications1,2

Quick return to normal activities, mild post-operative pain, low recurrence rate, respect for anorectal physiology and high rate of resolution or improvement of symptoms are the main reasons of high patient satisfaction3,4.


  1. Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial Available for Open Online Access. Ratto C., Parello A., Veronese E., Cudazzo E., D’Agostino E., Pagano C., Cavazzoni E., Brugnano L. & Litta F. Colorectal Disease 2015 Jan;17(1):O10-9.
  2. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single‑center study on 1000 consecutive cases and a review of the literature. Ratto C., Campenni P., Papeo F. et al. Tech Coloproctol. (2017) 21:953-962.
  3. Evaluation of Transanal Hemorroidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorroids, C. Ratto et al., Dis Colon Rectum 2010; 53 (5): 803-811.
  4. Evaluation of the effectiveness and patients’ contentment with transanal haemorrhoidal artery dearterialisation and mucopexy (THD) for treatment of haemorrhoidal disease: a 6-year study, Qurat Ul Ain et al, Irish Journal of Medical Science, Published online 6° December 2017.


THD® Doppler Procedure positive outcomes are supported by scientific literature, independent associations and institutes, and long-term clinical evidence.

NICE Interventional procedure Guidance

In 2010, the National Institute for Health and Clinical Excellence (NICE) acknowledged doppler-guided hemorrhoidal artery ligation as an efficacious alternative to hemorrhoidectomy or stapled haemorrhoidopexy. NICE is an independent British institute that issues influential guidelines in the healthcare sector, but is also accredited by the international scientific community.

In May 2010, NICE issued an interventional procedure guidance for hemorrhoidal artery ligated dedicated to THD® Doppler Procedure: “Treating Haemorrhoids by tying off their blood supply” (IPG342).

ASCRS Clinical Practice Guidelines

Recently, the American Society of Colon and Rectal Surgeons (ASCRS) issued new clinical practice guidelines for the management of hemorrhoids. ASCRS is committed to defining high quality patient care for colorectal disorders, based on the best available clinical evidence.

In 2018 ASCRS guidelines listed Doppler-guided hemorrhoidal artery ligation with mucopexy among surgical treatments for hemorrhoids, based on the review of 28 prospective studies for a total of 2904 patients with grade I to IV hemorrhoids.

Clinical Evidence and Scientific literature

Today the THD® Doppler procedure efficacy is proven by long-term clinical evidence and authoritative scientific studies, being recognized as an effective and safe surgical method by healthcare professionals worldwide.

More information on THD scientific literature is available at Clinical Studies.

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