Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial
Ratto C., Parello A., Veronese E., Cudazzo E., D’Agostino E., Pagano C., Cavazzoni E., Brugnano L. & Litta F. Colorectal Disease 2015 Jan;17(1):O10-9
This multicentre study, based on the largest patient population ever published, aims to evaluate the efficacy of a Doppler guided THD (THD® Doppler) in the treatment of symptomatic haemorrhoids and to identify predictive failure factors for an effective mid-term outcome.
803 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 analysis of the potential predictive factors of failure was performed.
The morbidity rate was 18.0%, and it was represented mainly by pain or tenesmus (106 patients, 13.0%). Acute bleeding requiring surgical haemostasis occurred in 7 patients (0.9%). No serious or life-threatening complication 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%), 5 (0.6%) patients, respectively. Sixteen out of 47 re-operated patients underwent a conventional haemorrhoidectomy. All the symptoms were significantly improved in each domain of the score (p<0.0001). At multivariate analysis the absence of morbidity and performing a distal Doppler-guided dearterialization were associated to a better outcome.
THD® Doppler is a safe and effective therapy of 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.