TRANSANAL HEMORRHOIDAL DEARTERIALIZATION. A NEW SURGICAL ALTERNATIVE

Abstract

Hemorrhoid dearterialisation is a technique developed in the last decade, consisting of ligation of hemorrhoidal artery through a proctoscope which contains a Doppler, with the subsequent mucosal pexy. Objective: To analyze the feasibility of the generalization of this procedure, mentioning its advantages and possible disadvantages in the use of the same. Methods: We conducted a descriptive study which included 41 patients (20 male and 21 female) ages between 23 and 55 years, with II, symptomatic III and IV haemorrhoids without symptoms of obstructed defecation, operated in the service of Surgery 2 of the Hospital Domingo Luciani and Unit of Colon, Rectum and Anus at the Centro Clínico Leopoldo Aguerrevere, from June 2012 to March 2014. The technique involves the ligation of terminal branches of the hemorrhoidal arteries in radial 1, 3, 5, 7.9 and 11. The average time of the procedure was 39.26 minutes. The follow-up of the patients was carried out a week, fifteen days, a month and three
months, assessing satisfaction of the technique based on pain, reduction of prolapse and complications. Results: Were follow-up 41 patients in consultation, the 48.8% with age range between 31-40 years, 61% with hemorrhoids III, 27% hemorrhoid II and 12% hemorrhoid IV. During the surgical procedure were 6 pexy the 80.5%. The plicomas be resected in all patients presenting with it. The symptoms referred to in the first 7 days individually or associated to other symptoms were tenesmus 68.3%, 39%, moderate in 21.9 pain perianal discomfort %, severe pain in 14.6%, bleeding and mild pain in 9.7% and thrombosis in 2.4%, also 14.6% not reported any symptoms. To relate the resection of plicomas with perianal pain it was observed severe pain in 15.4% of the patients resected to 25% of patients not resected. Immediate postoperative satisfaction was good at 39 % and very good at 34 %, it was just bad at 3 %. To apply a scale of analog display of pain there is a progressive tendency in the successive controls at 0-1 19.5% at 15 days, 30 days 78% and 85.3% at 90 days. In patients undergoing anorectal manometry were demonstrated an increase in resting pressures. 83% returned to their usual  activities on average at 3 weeks of the postoperative period. There were no major complications, some package hemorrhoidal prolapse was presented at the 29.4% of the patients. Conclusions: THD is a safe method, minimally invasive, with good results in the treatment of well selected patients with hemorrhoids II, III and IV. Future controlled trials comparing with other procedures, to demonstrate the real advantage and define appropriate physiological
indications, as well as to control long-term studies should be performed.