Transanal hemorrhoidal dearterialization
Encyclopedia
Transanal hemorrhoidal dearterialization (THD) is a surgical
procedure for the treatment of internal hemorrhoid
s.
s. Dal Monte et al. further refined this technique, introducing transanal hemorrhoidal dearterialization (THD). THD belongs to the category of minimally invasive surgery, since the procedure does not comprise incisions or removal of the hemorrhoidal tissue.
transducer to identify the hemorrhoidal arteries (originating from the superior rectal artery
) 2–3 cm above the dentate line and to suture them. By arterial ligation the blood inflow is reduced.
In case of redundant prolapse, the prolapsed mucosal membrane is lifted and sutured (with the last suture minimum 5 mm above the dentate line), repositioning hemorrhoidal cushions in situ.
THD can be performed with conscious sedation, local
or general anesthesia.
with plenty of liquids (approx. two litres per day) is recommended.
For most patients, the hospital stay lasts one day and normal activities can be resumed on average two to three days post-operatively.
The affected areas usually restore their normal anatomy after two to three months.
, hematoma
and thrombosis
were included among arising complications.
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
procedure for the treatment of internal hemorrhoid
Hemorrhoid
Hemorrhoids or haemorrhoids , are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of...
s.
Background
In 1995, Morinaga et al. developed a non-excisional surgical technique for the treatment of internal hemorrhoidHemorrhoid
Hemorrhoids or haemorrhoids , are vascular structures in the anal canal which help with stool control. They become pathological or piles when swollen or inflamed. In their physiological state they act as a cushion composed of arterio-venous channels and connective tissue that aid the passage of...
s. Dal Monte et al. further refined this technique, introducing transanal hemorrhoidal dearterialization (THD). THD belongs to the category of minimally invasive surgery, since the procedure does not comprise incisions or removal of the hemorrhoidal tissue.
The procedure
Transanal hemorrhoidal dearterialization (THD) uses a specially developed proctoscope combined with a DopplerDoppler
-Doppler effect and its applications:* Doppler effect* Doppler beaming* Doppler broadening* Doppler cooling** Doppler cooling limit* Doppler echocardiography** Doppler ultrasound, also called Doppler sonography** Transcranial doppler* Doppler fetal monitor...
transducer to identify the hemorrhoidal arteries (originating from the superior rectal artery
Superior rectal artery
The superior rectal artery is an artery that descends into the pelvis to supply blood to the rectum.-Structure:The superior rectal artery is the continuation of the inferior mesenteric artery...
) 2–3 cm above the dentate line and to suture them. By arterial ligation the blood inflow is reduced.
In case of redundant prolapse, the prolapsed mucosal membrane is lifted and sutured (with the last suture minimum 5 mm above the dentate line), repositioning hemorrhoidal cushions in situ.
THD can be performed with conscious sedation, local
Local anesthesia
Local anesthesia is any technique to induce the absence of sensation in part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with...
or general anesthesia.
Post-operative course
After the operation, a high-fiber dietDietary fiber
Dietary fiber, dietary fibre, or sometimes roughage is the indigestible portion of plant foods having two main components:* soluble fiber that is readily fermented in the colon into gases and physiologically active byproducts, and* insoluble fiber that is metabolically inert, absorbing water as it...
with plenty of liquids (approx. two litres per day) is recommended.
For most patients, the hospital stay lasts one day and normal activities can be resumed on average two to three days post-operatively.
The affected areas usually restore their normal anatomy after two to three months.
Post-operative complications
Reports on this procedure showed low complication rates and lower postoperative pain. Bleedings, urinary retentionUrinary retention
Urinary retention, also known as ischuria, is a lack of ability to urinate. It is a common complication of benign prostatic hyperplasia , although it can also be caused by nerve dysfunction, constipation, infection, or medications...
, hematoma
Hematoma
A hematoma, or haematoma, is a localized collection of blood outside the blood vessels, usually in liquid form within the tissue. This distinguishes it from an ecchymosis, which is the spread of blood under the skin in a thin layer, commonly called a bruise...
and thrombosis
Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...
were included among arising complications.