Abstract
Hemorrhoidal disease is a recurrent anorectal complaint in the surgeon’s office, with a 5% prevalence in general population. Several new techniques and devices have been developed, such as transanal hemorrhoidal dearterialization (THD). THD aims to reduce the hemorrhoidal blood flow through Doppler-guided ligation of the terminal branches of hemorrhoidal arteries and to provide application of the redundant rectal mucosa/submucosa (mucopexy). The surgery is fully performed in the distal rectum, avoiding the somatic innervation of the perianal skin, minimizing postoperative pain and thus providing faster recovery.
Transanal hemorrhoidal dearterialization, as any other surgical technique for hemorrhoids, should be offered to patients with symptomatic hemorrhoidal disease, despite clinical treatment. Patients who most benefit from THD are those with bleeding or prolapsed internal hemorrhoids. Patients whose symptoms are due to skin tags or external hemorrhoids will not benefit just because the technique is performed completely above the dentate line.
No enemas or bowel preparation are done before surgery because too soft or liquid stools can run through the anal canal making visualization difficult. Both general and spinal anesthesia are safe and effective for hemorrhoid surgery.
To perform the dearterialization, an “X-stitch” is performed at the place of the Doppler signal at the six main hemorrhoidal arteries branches.
To perform the mucopexy, using a conventional needle holder, it is performed a nonanchored continuous suture, involving mucosa and submucosa distally to the place where the dearterialization was performed.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
Dal Monte PP et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338
Johanson JF, Sonnenberg A (1990) The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 98(2):380–386
Khan KI et al (2014) Role of prophylactic antibiotics in Milligan Morgan hemorrhoidectomy – a randomized control trial. Int J Surg 12(8):868–871
Morinaga K et al (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90:610–613
Nelson DW et al (2014) Prophylactic antibiotics for hemorrhoidectomy: are they really needed? Dis Colon Rectum 57(3):365–369
Ratto C et al (2012) Assessment of haemorrhoidal artery network using colour duplex imaging and clinical implications. Br J Surg 99:112–118
Ratto C et al (2015) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Color Dis 17(1):O10–O19
Similis C et al (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102(13):1603–1618
Toyonaga T et al (2006) Postoperative urinary retention after surgery for benign anorectal disease: potential risk factors and strategy for prevention. Int J Color Dis 21(7):676–682
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this entry
Cite this entry
Klajner, S., Sampaio, R.C., Azevedo, B.C., Dantas, A.C.B., Joaquim, H.D.G. (2018). Technical Tips and Tricks of Dearterialization of Hemorrhoids and Mucopexy. In: Ratto, C., Parello, A., Litta, F. (eds) Hemorrhoids. Coloproctology, vol 2. Springer, Cham. https://doi.org/10.1007/978-3-319-53357-5_37
Download citation
DOI: https://doi.org/10.1007/978-3-319-53357-5_37
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-53356-8
Online ISBN: 978-3-319-53357-5
eBook Packages: MedicineReference Module Medicine