What is the role of Doppler-guided transanal hemorrhoidal dearterialization (THD Doppler) in the treatment of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

Doppler-guided transanal hemorrhoidal dearterialization (THD Doppler) appears to be a promising procedure in the treatment of hemorrhoids. A multicenter study that evaluated the safety and effectiveness of this technique in 803 patients with grade II symptomatic hemorrhoidal disease, with a rectal mucopexy in patients with hemorrhoidal prolapse, reported an overall success rate of 90.7% and an overall morbidity of 18.0% (pain or tenesmus in 13.0%). [53] Fifty-one patients (6.3%) had a recurrence of hemorrhoidal prolapse, 19 (2.4%) had bleeding, and 5 (0.6%) suffered both. Sixteen of 47 patients required reoperation with a conventional hemorrhoidectomy. [53]

In an observational study of 402 outpatients who underwent transanal dearterialization for grade II-IV hemorrhoids, complications occurred in 16.7% and the rate of recurrent disease was below 10% for each group. [54]  Bleeding and hemorrhoidal thromboses were the most common complications, with 10 cases each. Of patients with grade II disease (n =16), 6.3% had recurrent disease; grade III (n = 210), 5.8%; and grade IV (n = 176), 9.7%. The investigators indicated advantages of transanal dearterialization include mild pain, fast recovery, low complication rate, and early return to daily activities. [54]


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