'Distal Doppler-guided dearterialization' is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization.
OBJECTIVE
Transanal haemorrhoidal dearterialization (THD® Doppler) is a surgical procedure involving Doppler-guided ligation of haemorrhoidal arteries to reduce arterial flow. With proximal Doppler-guided dearterialization, arterial ligation is achieved by introducing the proctoscope completely into the anal canal and lower rectum. In the present study, distal Doppler-guided dearterialization (DDD) is performed in the distal 2 cm of the lower rectum. Immediate and short-term results were evaluated.


METHODS
One hundred patients with bleeding haemorrhoids, with or without muco-haemorrhoidal prolapse, underwent THD® Doppler procedure, using DDD of the haemorrhoidal arteries 2 cm above the anorectal junction. Mucopexy was performed in patients with haemorrhoidal prolapse.


RESULTS
The operation time was 20 ± 7 min for dearterialization alone (10 patients), and 30 ± 10 min when mucopexy was added (90 patients). Morbidity included: transient haemorrhoidal thrombosis (two patients); urinary retention (five patients); submucosal abscess (one patient). No patient complained of faecal incontinence. At a median follow-up of 7.3 (3-17) months, all patients reported an improvement in symptoms. No patients reported bleeding.


CONCLUSIONS
DDD of the haemorrhoidal arteries could be a simplified and more effective method of applying THD.
Department of Surgical Sciences, Catholic University, Rome, Italy. carloratto@tiscali.it
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De Simone
D001003:Anal Canal / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation / Q000379:methods; D012007:Rectum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler