Why and When I Do Prefer the Dearterialization of Hemorrhoids and Mucopexy

Abstract

Transanal hemorrhoidal dearterialization represents a valid treatment for second- and third-degree hemorrhoids. Its introduction 20 years ago, followed by many technical adjustments and improvements, brought an important “non-excisional” option to resolve a frequent proctological problem. Starting from the anatomic, physiologic, and physiopathologic knowledges of the hemorrhoidal disease, associated with the evaluation of the encouraging results obtained, many surgeons have been starting to identify this technique as an optimal compromise because of the patient’s satisfaction and the reduction of postoperative pain, associated with acceptable long-term recurrence rate when compared with other “milestones” techniques. An important step to obtain worldwide acceptance has been done when evaluating the efficacy of the technique in selected degrees of hemorrhoids: if at the beginning of the experience the data were obtained regardless of the degree of the disease, then many trials started to select specific patients to obtain more homogenous results to better clarify the efficacy of the technique. The aim of this chapter is to briefly summarize the correct indications for this technique to obtain good outcomes and reduce the failure of the treatment.