Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids.

PURPOSE Transanal hemorrhoidal dearterialization is an innovative technique to treat hemorrhoids using a specially designed proctoscope for Doppler-guided transanal ligation of hemorrhoidal arteries. We analyzed results of experience at a single-institution with this transanal hemorrhoidal dearterialization device. METHODS Overall, 170 patients were submitted to transanal hemorrhoidal dearterialization during the period July 2005 through October 2008. The operation consisted of hemorrhoidal dearterialization (of 6 arteries) in all patients, with major mucosal/submucosal pexy in 56 patients (32.9%). The first consecutive 11 patients (6.4%) were treated under general/spinal anesthesia, the remaining 159 (93.6%) by sedation with propofol, supported by analgesia with remifentanil. Following transanal hemorrhoidal dearterialization surgery, patients were regularly evaluated at 2 weeks, 1 and 3 months, and once a year after operation. RESULTS The mean age of the 170 patients was 47.3 +/- 13.0 years; 102 (60%) were men. Hemorrhoidal disease was grade II in 13 (7.6%); grade III in 141 (82.7%), and grade IV in 16 (9.6%). Postoperative bleeding requiring surgical hemostasis occurred in 2 cases (1.2%). Mean follow-up was 11.5 +/- 12 (range, 1-41) months. Hemorrhoidal thrombosis occurred in 4 patients (2.3%), chronic pain and fecal incontinence in none. Hemorrhoidal prolapse was reported at follow-up by 50 patients (29.5%), but prolapse was confirmed only in 18 (10.5%) and was mild; some patients reporting prolapse were found to have skin tags. Overall, long-term control of bleeding was obtained in 159 patients (93.5%) and control of prolapse in 152 (89.5%). Recurrence of hemorrhoidal disease requiring surgery was found in 7 patients (4.1%). CONCLUSIONS Transanal hemorrhoidal dearterialization appears to be a very effective minimally invasive option to treat hemorrhoids and can be performed in a day-surgery setting. Future controlled trials comparing transanal hemorrhoidal dearterialization with other procedures will show the real potential of transanal hemorrhoidal dearterialization and define adequate indications for this approach.