Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids.
OBJECTIVE
Transanal haemorrhoidal dearterialization (THD) has become well established for the treatment of haemorrhoids. In this study we describe a technical modification of this technique, targeted mucopexy (THD TM), and report the results for advanced haemorrhoids.


METHODS
The study included a prospective evaluation of patients with Grade IV (fourth-degree) haemorrhoids operated on with the THD TM technique. This consisted of an initial dearterialization when the haemorrhoidal arteries were transfixed and a second phase of mucopexy, using a different needle from that usually used in the original technique.


RESULTS
From January 2007 to December 2011, 31 consecutive patients with Grade IV haemorrhoids were operated on using the THD TM technique. Postoperative pain was reported by 22 (70%) patients on day 1 and 19 (61%) on day 7, while nine (30%) did not experience any pain at all. Severe pain was reported by only nine (16%) patients. At a mean follow-up of 32 months, two (6.4%) patients required a further intervention for on-going symptoms.


CONCLUSIONS
Transanal haemorrhoidal dearterialization TM is effective for advanced haemorrhoids.
Department of Colorectal Surgery, Barts Health, London, UK.
P
P
Giordano
I
I
Tomasi
A
A
Pascariello
E
E
Mills
S
S
Elahi
D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000098:blood supply* / Q000601:surgery; D001158:Arteries / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006484:Hemorrhoids / Q000145:classification / Q000601:surgery*; D006801:Humans; D007413:Intestinal Mucosa / Q000601:surgery*; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology*; D011446:Prospective Studies; D012007:Rectum / Q000098:blood supply* / Q000601:surgery; D019233:Retreatment; D013536:Suture Techniques; D014463:Ultrasonography; D055815:Young Adult
Haemorrhoids; haemorrhoidal artery ligation; targeted mucopexy; transanal haemorrhoidal dearterialization