title: Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease.
abstract: BACKGROUND
  This prospective, observational study evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD).
  
  
  METHODS
  THD was performed under sedation-locoregional anesthesia in 402 outpatients. Patients had follow-up evaluation 3 days, 2 weeks, 1, 6 and 12 months postoperatively. Postoperative complications and recurrence of symptoms at 12 months were analyzed. The relationship between the learning curve and the number of postoperative complications was studied.
  
  
  RESULTS
  Mean patient age was 46.4 (range 20-85) years. A total of 268 patients (66.6%) were male. Sixteen patients (4.0%) had grade 2 HD, 210 (52.2%) had grade 3 and 176 (43.8%) had grade 4 HD. Surgery lasted 23 (17-34) min. A total of 67 patients had complications: bleeding in 10 patients (2.5%), hemorrhoidal thromboses in 10 (2.5%), perianal fistulas in 5 (1.2%), fissures in 14 (3.5%), urinary retention in 3 (0.8%), residual prolapse in 19 (4.7%), severe anal pain in 3 (0.8%), and perianal abscess in 3 patients (0.8%). Recurrent HD occurred in 6.3% (1/16) of grade 2 HD patients, 5.8% (12/210) of grade 3 patients and 9.7% (17/176) of grade 4 patients. Twelve months after THD, bleeding was controlled in 363 patients (90.5%), prolapse was controlled in 391 (97.3%) and pain markedly improved in 390 patients (97%).
  
  
  CONCLUSIONS
  THD appears safe and effective for grade 2-4 HD, and the number of complications decreased with increasing surgeon experience. THD advantages include mild pain, fast recovery, early return to daily activities and low incidence of complications.
authors: Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia. Electronic address: vojislavma2@sbb.rs.
authors: Zoran
authors: Z
authors: Bjelanovic
authors: Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia.
authors: Miroljub
authors: M
authors: Draskovic
authors: Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrado, Serbia.
authors: Milic
authors: M
authors: Veljovic
authors: Clinic for Vascular and Endovascular Surgery, Military Medical Academy, Belgrado, Serbia.
authors: Ivan
authors: I
authors: Lekovic
authors: Department of Anesthesiology, Washington University School of Medicine, San Luis, Misuri, Estados Unidos.
authors: Menelaos
authors: M
authors: Karanikolas
authors: Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrado, Serbia.
authors: Dusica
authors: D
authors: Stamenkovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001003:Anal Canal; D001158:Arteries / Q000601:surgery; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects / Q000379:methods*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Arteries; Desarterialización transanal; Doppler; Hemorrhoids; Hemorroides; Hemorroidopexia; Ligadura arterial; Ligation; Mucopexy; Transanal dearterialization