Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy.
BACKGROUND
Transanal hemorrhoidal dearterialization (THD), a new approach for patients who would otherwise require an operative hemorrhoidectomy, accomplishes hemorrhoidal symptom relief with far less postoperative pain than an operative hemorrhoidectomy.


METHODS
THD, an ambulatory procedure, employs a specially designed proctoscope coupled with a Doppler transducer to allow identification and suture ligation of the hemorrhoidal arteries.


RESULTS
Sixty patients between ages 22 and 87 were treated. Bleeding was fully corrected in 88%, protrusion in 92%, and pain in 71%. Two patients (3%) failed to improve with THD. Complications included pain resulting in greater than 2 days loss of work in 5 patients, postoperative perirectal thromboses developed in 4 patients, and an anal fissure developed in 1 patient.


CONCLUSIONS
THD was an effective alternative to operative hemorrhoidectomy. It may be the only option for patients where an operative hemorrhoidectomy is contraindicated because of incontinence.
Sohn
N
N
Department of Surgery, Lenox Hill Hospital, New York, NY, USA. nsohn@ssamed.com
Aronoff
J S
JS
Cohen
F S
FS
Weinstein
M A
MA
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D020700:Proctoscopes; D011351:Proctoscopy; D013536:Suture Techniques