Doppler‐guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. (January 2015)

• Record Type: Journal Article
• Authors: Ratto, C.; Parello, A.; Veronese, E.; Cudazzo, E.; D'Agostino, E.; Pagano, C.; Cavazzoni, E.; Brugnano, L.; Litta, F.
• Is Part Of: Colorectal disease. Volume 17:Number 1(2015)
• Page Start: O10
• Page End: O19
• Publication Date: 2015-01
• Subjects: Colon (Anatomy) -- Diseases -- Periodicals; Rectum -- Diseases -- Periodicals; 616.34
• DOI: 10.1111/codi.12779
• Languages: English
• ISSNs: 1462-8910

Abstract

<abstract abstract-type="main" id="codi12779-abs-0001"> <title>Abstract</title> <sec id="codi12779-sec-0001" sec-type="section"> <title>Aim</title> <p>This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of Doppler‐guided transanal haemorrhoidal dearterialization (THD Doppler) in the treatment of symptomatic haemorrhoids and to identify the factors predicting failure for an effective mid‐term outcome.</p> </sec> <sec id="codi12779-sec-0002" sec-type="section"> <title>Method</title> <p>Eight hundred and three patients affected by Grade II (137, 17.1%), III (548, 68.2%) and IV (118, 14.7%) symptomatic haemorrhoidal disease underwent THD Doppler, with a rectal mucopexy in patients with haemorrhoidal prolapse. The disease was assessed through a specifically designed symptom questionnaire and scoring system. A uni‐ and multivariate analyses of the potential predictive factors for failure were performed.</p> </sec> <sec id="codi12779-sec-0003" sec-type="section"> <title>Results</title> <p>The morbidity rate was 18.0%, represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in seven patients (0.9%). No serious or life‐threatening complications occurred. After a mean follow‐up period of 11.1 ± 9.2 months, the overall success rate was 90.7% (728 patients), with a recurrence of haemorrhoidal prolapse, bleeding, and both symptoms in 51 (6.3%), 19 (2.4%) and 5 (0.6%) patients, respectively. Sixteen out of 47 patients undergoing re‐operation had a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (<italic>P </italic><<italic> </italic>0.0001). At multivariate analysis the absence of morbidity and performance of a distal Doppler‐guided dearterialization were associated with a better outcome.</p> </sec> <sec id="codi12779-sec-0004" sec-type="section"> <title>Conclusion</title> <p>THD Doppler is a safe and effective therapy for haemorrhoidal disease. If this technique is to be employed, an accurate distal Doppler‐guided dearterialization and a tailored mucopexy are mandatory to contain and reduce the symptoms.</p> </sec> </abstract>