title: Transanal haemorrhoidal dearterialization for the treatment of grade III and IV haemorrhoids: a 3-year experience.
abstract: BACKGROUND
  Transanal haemorrhoidal dearterialization (THD) is increasingly perceived as an effective and better tolerated alternative to excisional haemorrhoidectomy. The aim of this study was to evaluate outcomes and the patient experience of THD in an Australian population with grade III or IV haemorrhoids.
  
  
  METHODS
  A retrospective review of prospectively maintained database on patients who had undergone THD over a 3-year period was performed. Data were collected on demographics, operative data, complications, recurrences and readmissions, postoperative pain and further interventions. Patient perceptions and satisfaction with the procedure were assessed with a telephone survey.
  
  
  RESULTS
  A total of 85 patients with a mean age of 55 (±14) years with grade III (85%) or grade IV (15%) haemorrhoids underwent THD. Indications for surgery were predominantly bleeding (87%) and prolapse (41%). Median outpatients follow-up was 42 days and median telephone follow-up was 802 days. Median operating time was 25 min (±12). Twenty-four per cent of patients suffered complications, including postoperative bleeding (7%), constipation (7%), local sepsis (6%), anal fissure (5%) and temporary incontinence (2%). Severe postoperative pain occurred in 16% of the patients. The symptom recurrence rate was 19% and reintervention rate was 14%. About 98.8% of patients reported good or excellent overall satisfaction with the procedure.
  
  
  CONCLUSIONS
  THD is a relatively new technique for the treatment of haemorrhoids, which is increasingly being used as an alternative to excisional haemorrhoidectomy. This study shows that patients' satisfaction with THD is high despite a moderate complication and recurrence rate and significant incidence of postoperative pain.
authors.affiliation: Department of Colorectal Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: Arun
authors.initials: A
authors.lastname: Loganathan
authors.affiliation: Department of Colorectal Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: Atandrilla
authors.initials: A
authors.lastname: Das
authors.affiliation: Department of Colorectal Surgery, Lyell McEwin Hospital, Adelaide, South Australia, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Luck
authors.affiliation: Department of Colorectal Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Hewett
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery; D001158:Arteries / Q000601:surgery*; D001315:Australia; D005260:Female; D061865:Hemorrhoidectomy / Q000379:methods*; D006484:Hemorrhoids / Q000145:classification / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D019106:Postoperative Hemorrhage / Q000209:etiology; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
keywords: haemorrhoid; haemorrhoid artery ligation; transanal haemorrhoid dearterialization