Delorme like Transanal Haemorrhoidal Dearterialization for the Treatment of Haemorrhoidal Disease

Transanal Haemorrhoidal Dearterialization (THD) has been increasingly used as an alternative technique to conventional surgery for the treatment of haemorrhoidal disease (HD) [1]. The association of mucopexy to the simple dearterialization makes THD suitable for fourth-degree HD, when the prolapsing component plays a major role in symptoms development [2]. Performing THD, as originally described [3], can be sometimes difficult in patients with a particularly redundant mucosal prolapse. Specifically, when the surgeon ties the first continuous suture to perform the mucopexy just below the dearterialization site, the adjacent rectal mucosa fold towards the dentate line creating a mucosal “pocket” which makes the next running suture difficult to be correctly placed (Fig. 1 a,b). The mucosal folding increases progressively with the number of completed sites of mucopexy, Abstract