Comparison of Doppler-Guided Transanal Hemorrhoidal Dearterialization for Grade III and IV Hemorrhoids in Vietnam
This study aimed to assess the short- and long-term outcomes of Doppler-guided transanal hemorrhoidal dearterialization (THD) for grade III and IV hemorrhoidal disease in Vietnam.
In a prospective observational design, patients treated for grade III and IV hemorrhoidal disease with the THD method at the National Hospital of Traditional Medicine (Hanoi, Vietnam) were included between June 2012 and December 2013. Patients were evaluated postoperatively at the time they were discharged from the hospital (short-term outcome) and 6 months after surgery (long-term outcome).
A total of 128 patients were enrolled in the study, 94 were classified with grade III disease and 34 with grade IV. Grade IV hemorrhoidal patients reported on average 18.2 years of disease symptom duration, while grade III hemorrhoidal patients reported 11.2 years. All patients with grade III and grade IV hemorrhoidal disease had good outcomes at discharge day and reported to return to work in a median of 6 days after THD. At long-term follow-up, the results were good for 80.9% of patients from grade III hemorrhoidal disease and 61.8% of patients from grade IV hemorrhoidal disease. Patient satisfaction with the procedure and outcomes was 93.6% for grade III and 85.3% for grade IV hemorrhoidal patients.
The THD technique was shown to be safe for both grade III and IV hemorrhoidal patients. The THD technique showed better results with grade III hemorrhoidal patients as compared to grade IV hemorrhoidal patients.
KeywordsDearterialization Doppler-guided THD Hemorrhoidal artery ligation Hemorrhoids Vietnam
The authors thank patients and healthcare professionals who participated in this study.
No funding or sponsorship was received for this study or publication of this article. The article processing charges were funded by the authors.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
The authors (Le Manh Cuong, Tran Thu Ha, Nguyen Ngoc Anh, Nguyen Tien Thanh, Vu Duy Kien and Nguyen Duc Lam) have nothing to disclose.
Compliance with Ethics Guidelines
All procedures performed in studies involving human participants were in accordance with the ethical standards of the Military Medical University committee, Vietnam and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval to conduct the study was obtained from the committee of the Military Medical University, Vietnam by the Decision no. 2858/QD-HVQY. Informed consent was obtained from all individual participants included in the study.
The datasets generated during and/or analyzed during the current study are available in the Figshare repository, https://doi.org/10.6084/m9.figshare.7560437.
- 4.Ratto C, Campenni P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017;21(12):953–62. https://doi.org/10.1007/s10151-017-1726-5.CrossRefGoogle Scholar
- 5.Kandilarov N, Dimitrova V. Hemorrhoidal disease—contemporary aspects of the pathogenesis, clinical course, diagnosis and treatment. Khirurgiia (Sofiia). 2015;81(1):38–56.Google Scholar
- 15.Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017;21(5):337–44. https://doi.org/10.1007/s10151-017-1620-1.CrossRefGoogle Scholar
- 16.Hoyuela C, Carvajal F, Juvany M, et al. HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up. Int J Surg. 2016;28:39–44. https://doi.org/10.1016/j.ijsu.2016.02.030.CrossRefGoogle Scholar
- 18.Xu L, Chen H, Lin G, Ge Q, Qi H, He X. Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Tech Coloproctol. 2016;20(12):825–33. https://doi.org/10.1007/s10151-016-1551-2.CrossRefGoogle Scholar
- 19.Haskins IN, Holzmacher J, Obias V, Agarwal S. The use of transanal hemorrhoidal dearterialization for treatment of hemorrhoid disease at a single institution. Am Surg. 2016;82(12):1160–2.Google Scholar
- 20.Lwanga SK, Lemeshow S, World Health Organization. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991.Google Scholar
- 21.Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V. Distal Doppler-guided dearterialization’ is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis. 2012;14(11):e786–9. https://doi.org/10.1111/j.1463-1318.2012.03146.x.CrossRefGoogle Scholar
- 22.Bjelanovic Z, Draskovic M, Veljovic M, Lekovic I, Karanikolas M, Stamenkovic D. Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease. Cir Esp. 2016;94(10):588–94. https://doi.org/10.1016/j.ciresp.2016.07.002.CrossRefGoogle Scholar
- 24.Leardi S, Pessia B, Mascio M, Piccione F, Schietroma M, Pietroletti R. Doppler-guided transanal hemorrhoidal dearterialization (DG-THD) versus stapled hemorrhoidopexy (SH) in the treatment of third-degree hemorrhoids: clinical results at short and long-term follow-up. J Gastrointest Surg. 2016;20(11):1886–90. https://doi.org/10.1007/s11605-016-3220-1.CrossRefGoogle Scholar
- 25.Infantino A, Altomare DF, Bottini C, et al. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis. 2012;14(2):205–11. https://doi.org/10.1111/j.1463-1318.2011.02628.x.CrossRefGoogle Scholar
- 30.Venturi M, Salamina G, Vergani C. Stapled anopexy versus transanal hemorrhoidal dearterialization for hemorrhoidal disease: a three-year follow-up from a randomized study. Minerva Chir. 2016;71(6):365–71.Google Scholar
- 31.Verre L, Rossi R, Gaggelli I, Di CB, Tirone A, Piccolomini A. PPH versus THD: a comparison of two techniques for III and IV degree haemorrhoids. Personal experience. Minerva Chir. 2013;68(6):543–50.Google Scholar