[Doppler-guided transanal haemorrhoidal dearterialisation. An alternative treatment for haemorrhoids].
BACKGROUND
The frequency of haemorrhoid disease and the deterioration in the quality of life in the immediate post-operative period has led to the appearance of new techniques in an attempt to obtain improve patient satisfaction.


METHODS
A prospective study was carried out in which 50 consecutive patients with a diagnosis of Goligher grade III haemorrhoids were intervened. To perform the haemorrhoid dearterialisation, a device called THD R was used (designed by TKC SRL and distributed by Palex Medical). The technique consisted of, a reduction in arterial flow using ligation of the terminal branches above the anorectal ring, starting in the anterior position, it was carried out in a clockwise direction: 1, 3, 5, 7, 9, 11. Follow up was carried out at one week, 1 month, 3 months, 6 months and 1 year.


RESULTS
We intervened 50 consecutive patients with a diagnosis of grade III haemorrhoids. The mean age was 45 years (range, 25-78). The surgical indication was, pain-discomfort, 40 (80%); bleeding, 35 (70%), prolapse 6 (12%). The procedure was always performed under local/regional anaesthesia. The mean duration of the procedure was 25 minutes (range, 20-35). Analgesia was required by 90% of the patients during the first 24 hours, decreasing to 15% for those who continued to require it until the third day and only 2 (4%) patients continued for one week. Pain was resolved 48 hours after surgery, in all patients who consulted for this reason, except for one patient (2.5%) who had a recurrence in the pain as well as in his prolapse. This meant that patients could re-start their daily living within 48-72 hours.


CONCLUSIONS
Pending for randomised studies, we can say that in our experience, Doppler guided transanal haemorrhoidal dearterialisation is a technique that should be offered to the patient with haemor-rhoidal disease.
Cantero
Ramón
R
Departamento de Cirugía, Universidad Complutense, Hospital Clínico Universitario San Carlos, Madrid, España. rcanteroc@medynet.com
Balibrea
José María
JM
Ferrigni
Carlos
C
Sanz
Manuel
M
García Pérez
Juan Carlos
JC
Pérez
Rosa
R
Luffiego
Angela
A
Forero
Raimundo G
RG
Balibrea
José Luis
JL
D000328:Adult; D000368:Aged; D001158:Arteries / Q000601:surgery; D005260:Female; D006484:Hemorrhoids / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000523:psychology; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D018608:Ultrasonography, Doppler