'Distal Doppler-guided dearterialization' is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization

AIM: Transanal haemorrhoidal dearterialization (THD® Doppler) is a surgical\r\nprocedure involving Doppler-guided ligation of haemorrhoidal arteries to reduce\r\narterial flow. With proximal Doppler-guided dearterialization, arterial ligation \r\nis achieved by introducing the proctoscope completely into the anal canal and\r\nlower rectum. In the present study, distal Doppler-guided dearterialization (DDD)\r\nis performed in the distal 2 cm of the lower rectum. Immediate and short-term\r\nresults were evaluated.\r\nMETHOD: One hundred patients with bleeding haemorrhoids, with or without\r\nmuco-haemorrhoidal prolapse, underwent THD® Doppler procedure, using DDD of the\r\nhaemorrhoidal arteries 2 cm above the anorectal junction. Mucopexy was performed \r\nin patients with haemorrhoidal prolapse.\r\nRESULTS: The operation time was 20 ± 7 min for dearterialization alone (10\r\npatients), and 30 ± 10 min when mucopexy was added (90 patients). Morbidity\r\nincluded: transient haemorrhoidal thrombosis (two patients); urinary retention\r\n(five patients); submucosal abscess (one patient). No patient complained of\r\nfaecal incontinence. At a median follow-up of 7.3 (3-17) months, all patients\r\nreported an improvement in symptoms. No patients reported bleeding.\r\nCONCLUSION: DDD of the haemorrhoidal arteries could be a simplified and more\r\neffective method of applying THD.