title: Doppler-guided ligation of hemorrhoidal arteries with mucopexy: A technique for the future.
abstract: OBJECTIVE
  The transanal hemorrhoidal de-arterialization (THD) procedure is an effective treatment of hemorrhoidal disease. The ligation of hemorrhoidal arteries ("de-arterialization") can provide a significant reduction of arterial blood flow to the hemorrhoidal tissues. Plication of redundant rectal mucosa/submucosa ("mucopexy") can reposition prolapsing tissue to its original anatomical site. In this paper the surgical technique using a specific device (THD(®) Doppler) and peri-operative patient management are illustrated.
  
  
  METHODS
  After appropriate clinical assessment, patients undergo the THD procedure under general or spinal anesthesia, in either the dorsal lithotomy or prone jackknife position. A specifically designed device is used. In all patients, THD is performed, consisting of selective ligation of hemorrhoidal arteries identified by Doppler and marked with a mucosal stitch overlying the artery. In patients with hemorrhoidal or mucosal prolapse, a mucopexy is also performed using continuous suture(s) that include the redundant prolapsing mucosa and submucosa.
  
  
  RESULTS
  In long-term follow-up, THD results in resolution of symptoms in the majority of patients. The most common complication is transient but sometimes-painful tenesmus. Rectal bleeding occurs in only a very limited number of patients. There is little or no risk of fecal incontinence or chronic pain. Ano-rectal manometry and endo-anal ultrasound show no evidence of injury to physiologic sphincteric function.
  
  
  CONCLUSIONS
  THD is a safe procedure and is, at present, one of the most effective treatments of hemorrhoidal disease.
authors.affiliation: Proctology Unit, Catholic University, 8, Largo A. Gemelli, 00168 Rome, Italy. Electronic address: carloratto@tiscali.it.
authors.forename: C
authors.initials: C
authors.lastname: Ratto
authors.affiliation: Service de Proctologie Médico-Chirurgicale, Groupe hospitalier Paris Saint-Joseph, Institut Léopold-Bellan, 185, rue Raymond-Losserand, 75014 Paris, France.
authors.forename: V
authors.initials: V
authors.lastname: de Parades
mesh_terms: D006484:Hemorrhoids / Q000000981:diagnostic imaging* / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods / Q000639:trends; D012007:Rectum / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000601:surgery*; D000067369:Transanal Endoscopic Microsurgery / Q000379:methods / Q000639:trends; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000639:trends; D018084:Ultrasonography, Interventional / Q000639:trends
keywords: Complication; De-arterialization; Hemorrhoidal artery; Hemorrhoids; Mucopexy; Prolapse; Recurrence