title: Transanal hemorrhoidal dearterialization: a systematic review.
abstract: OBJECTIVE
  Transanal hemorrhoidal dearterialization consists of a Doppler-guided ligation of the distal branches of the rectal arteries. The aim of this review is to assess the current evidence on dearterialization, establish the safety and efficacy of the technique, define its indications, and identify its possible advantages and limitations.
  
  
  METHODS
  All published studies on dearterialization without language restrictions were reviewed systematically. Primary outcome measures were postoperative pain and hemorrhoidal recurrences.
  
  
  RESULTS
  Seventeen articles including a total of 1,996 patients were analyzed. In general, the quality of the studies was low. Operating time ranged between 5 and 50 minutes. Hospital stay was one day for most patients, whereas the return to normal activities was between two and three days in most cases. Postoperative pain was present in 18.5% of patients. Three patients experienced significant postoperative hemorrhages. There were no other major complications. The overall recurrence rate was 9.0% for prolapse, 7.8% for bleeding, and 4.7% for pain at defecation. The recurrence rate at one year or more was 10.8% for prolapse, 9.7% for bleeding, and 8.7% for pain at defecation. When reported as a function of the hemorrhoidal grade, the recurrence rate was higher for fourth-degree hemorrhoids (range, 11.1-59.3%).
  
  
  CONCLUSIONS
  Transanal hemorrhoidal dearterialization appears to be a potential treatment option for second-degree and third-degree hemorrhoids. Clinical trials and longer follow-up comparing it with other procedures used to treat hemorrhoids are needed to establish a possible role for this technique.
authors.affiliation: Department of Surgery, Whipps Cross University Hospital, London, United Kingdom. pasquale.giordano@whippsx.nhs.uk
authors.forename: Pasquale
authors.initials: P
authors.lastname: Giordano
authors.forename: John
authors.initials: J
authors.lastname: Overton
authors.forename: Francesco
authors.initials: F
authors.lastname: Madeddu
authors.forename: Sabir
authors.initials: S
authors.lastname: Zaman
authors.forename: Gianpiero
authors.initials: G
authors.lastname: Gravante
mesh_terms: D001003:Anal Canal / Q000098:blood supply* / Q000601:surgery*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D011351:Proctoscopy; D013536:Suture Techniques