title: Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial.
abstract: OBJECTIVE
  This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler-guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid-term outcome.
  
  
  METHODS
  Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni- and multivariate analyses of the potential predictive factors for failure were performed.
  
  
  RESULTS
  The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life-threatening complications occurred. After a mean follow-up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re-operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (P < 0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler-guided dearterialization were associated with a better outcome.
  
  
  CONCLUSIONS
  THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler-guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.
authors.affiliation: Proctology Unit, Department of Surgical Sciences, Catholic University, Rome, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ratto
authors.forename: A
authors.initials: A
authors.lastname: Parello
authors.forename: E
authors.initials: E
authors.lastname: Veronese
authors.forename: E
authors.initials: E
authors.lastname: Cudazzo
authors.forename: E
authors.initials: E
authors.lastname: D'Agostino
authors.forename: C
authors.initials: C
authors.lastname: Pagano
authors.forename: E
authors.initials: E
authors.lastname: Cavazzoni
authors.forename: L
authors.initials: L
authors.lastname: Brugnano
authors.forename: F
authors.initials: F
authors.lastname: Litta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001003:Anal Canal / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D001158:Arteries; D005260:Female; D061865:Hemorrhoidectomy; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010149:Postoperative Pain / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology; D012005:Rectal Prolapse / Q000601:surgery; D012007:Rectum / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D055815:Young Adult
keywords: Haemorrhoids; haemorrhoidal disease; multivariate; prolapse; rectal bleeding; transanal haemorrhoidal dearterialization