Document Detail


Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids.
MedLine Citation:
PMID:  20389215     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Transanal hemorrhoidal dearterialization is an innovative technique to treat hemorrhoids using a specially designed proctoscope for Doppler-guided transanal ligation of hemorrhoidal arteries. We analyzed results of experience at a single-institution with this transanal hemorrhoidal dearterialization device. METHODS: Overall, 170 patients were submitted to transanal hemorrhoidal dearterialization during the period July 2005 through October 2008. The operation consisted of hemorrhoidal dearterialization (of 6 arteries) in all patients, with major mucosal/submucosal pexy in 56 patients (32.9%). The first consecutive 11 patients (6.4%) were treated under general/spinal anesthesia, the remaining 159 (93.6%) by sedation with propofol, supported by analgesia with remifentanil. Following transanal hemorrhoidal dearterialization surgery, patients were regularly evaluated at 2 weeks, 1 and 3 months, and once a year after operation. RESULTS: The mean age of the 170 patients was 47.3 +/- 13.0 years; 102 (60%) were men. Hemorrhoidal disease was grade II in 13 (7.6%); grade III in 141 (82.7%), and grade IV in 16 (9.6%). Postoperative bleeding requiring surgical hemostasis occurred in 2 cases (1.2%). Mean follow-up was 11.5 +/- 12 (range, 1-41) months. Hemorrhoidal thrombosis occurred in 4 patients (2.3%), chronic pain and fecal incontinence in none. Hemorrhoidal prolapse was reported at follow-up by 50 patients (29.5%), but prolapse was confirmed only in 18 (10.5%) and was mild; some patients reporting prolapse were found to have skin tags. Overall, long-term control of bleeding was obtained in 159 patients (93.5%) and control of prolapse in 152 (89.5%). Recurrence of hemorrhoidal disease requiring surgery was found in 7 patients (4.1%). CONCLUSIONS: Transanal hemorrhoidal dearterialization appears to be a very effective minimally invasive option to treat hemorrhoids and can be performed in a day-surgery setting. Future controlled trials comparing transanal hemorrhoidal dearterialization with other procedures will show the real potential of transanal hemorrhoidal dearterialization and define adequate indications for this approach.
Authors:
Carlo Ratto; Lorenza Donisi; Angelo Parello; Francesco Litta; Giovanni Battista Doglietto
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Diseases of the colon and rectum     Volume:  53     ISSN:  1530-0358     ISO Abbreviation:  Dis. Colon Rectum     Publication Date:  2010 May 
Date Detail:
Created Date:  2010-04-14     Completed Date:  2010-05-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0372764     Medline TA:  Dis Colon Rectum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  803-11     Citation Subset:  IM    
Affiliation:
Department of Surgical Sciences, Catholic University, Rome, Italy. carloratto@tiscali.it
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MeSH Terms
Descriptor/Qualifier:
Anal Canal / blood supply*,  surgery*
Chi-Square Distribution
Female
Hemorrhoids / surgery*
Hemostasis, Surgical
Humans
Male
Middle Aged
Patient Satisfaction
Postoperative Complications
Statistics, Nonparametric
Surgical Procedures, Minimally Invasive / methods*
Treatment Outcome
Ultrasonography, Interventional

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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