Transanal Hemorrhoid Dearterialization and mucopexy: a minimal invasive approach for prolapsed hemorrhoids. Four cases report.

Stefan Morarasu, Emmanuel Eguare, Yasir Bashir, Qurat ul Ain, Anca Bradu


Hemorrhoidal disease is one of the most frequent causes of anal pathology. Surgical therapy is reserved for patients who do not respond to non-operative management and for advanced third and fourth degree hemorrhoids. Milligan-Morgan and Ferguson hemorrhoidectomies are considered the first-choice therapy, but these procedures are associated with postoperative complications including infection, stenosis, pelvic floor dysfunction, rectal bleeding and postoperative pain. In order to minimize postoperative complications, less invasive procedures have been described and two of them are reported with promising results: Stapled hemorrhoidopexy (PPH) and Transanal Hemorrhoid Dearterialization (THD). THD involves ligation of the hemorrhoidal arteries under Doppler guidance resulting reduced inflow that facilitates reduction in size of hemorrhoids, while suture mucopexy addresses the prolapsed mucosa. THD is proven as a reliable technique for third degree hemorrhoids, but its role in fourth degree hemorrhoids is not generally accepted. Herein we report four cases of prolapsed hemorrhoids which were treated with THD and mucopexy. The procedure was successful in all patients. Photographs taken, before and after the procedure, show an impressive reduction of the prolapsed hemorrhoids. THD and mucopexy appears to be an effective technique with the potential of treating not only third degree, but advanced hemorrhoids as a safe one-day procedure with immediate visible results.


THD, Transanal hemorrhoidal dearterialization, hemorrhoids, hemorrhoidectomy

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