Transanal hemorrhoid dearterialization is a safe and effective outpatient procedure for the treatment of hemorrhoidal disease.
INTRODUCTION
This prospective, observational study evaluated transanal dearterialization (THD) efficacy and safety in grade 2-4 hemorrhoids (HD).


METHODS
THD was performed under sedation-locoregional anesthesia in 402 outpatients. Patients had follow-up evaluation 3 days, 2 weeks, 1, 6 and 12 months postoperatively. Postoperative complications and recurrence of symptoms at 12 months were analyzed. The relationship between the learning curve and the number of postoperative complications was studied.


RESULTS
Mean patient age was 46.4 (range 20-85) years. A total of 268 patients (66.6%) were male. Sixteen patients (4.0%) had grade 2 HD, 210 (52.2%) had grade 3 and 176 (43.8%) had grade 4 HD. Surgery lasted 23 (17-34) min. A total of 67 patients had complications: bleeding in 10 patients (2.5%), hemorrhoidal thromboses in 10 (2.5%), perianal fistulas in 5 (1.2%), fissures in 14 (3.5%), urinary retention in 3 (0.8%), residual prolapse in 19 (4.7%), severe anal pain in 3 (0.8%), and perianal abscess in 3 patients (0.8%). Recurrent HD occurred in 6.3% (1/16) of grade 2 HD patients, 5.8% (12/210) of grade 3 patients and 9.7% (17/176) of grade 4 patients. Twelve months after THD, bleeding was controlled in 363 patients (90.5%), prolapse was controlled in 391 (97.3%) and pain markedly improved in 390 patients (97%).


CONCLUSION
THD appears safe and effective for grade 2-4 HD, and the number of complications decreased with increasing surgeon experience. THD advantages include mild pain, fast recovery, early return to daily activities and low incidence of complications.
['Bjelanovic|Zoran|Z|', 'Draskovic|Miroljub|M|', 'Veljovic|Milic|M|', 'Lekovic|Ivan|I|', 'Karanikolas|Menelaos|M|', 'Stamenkovic|Dusica|D|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D000556:Ambulatory Surgical Procedures D001003:Anal Canal D001158:Arteries D005260:Female D061865:Hemorrhoidectomy D006484:Hemorrhoids D006801:Humans D008297:Male D008875:Middle Aged D011446:Prospective Studies D016896:Treatment Outcome D055815:Young Adult
Hemorrhoids Transanal dearterialization Arteries Desarterialización transanal Doppler Hemorroides Hemorroidopexia Ligadura arterial Ligation Mucopexy