Doppler-Guided Transanal Hemorrhoidal Dearterialization and Hemorrhoidopexy in Patients with Hemorrhoidal Disease
Keywords:
hemorrhoidal disease, hemorrhoidal dearterialization, hemorrhoidopexy, postoperative complicationsAbstract
Introduction: Transanal hemorrhoidal dearterialization is an innovative and minimally invasive technique, not free of postoperative complications.
Objective: To evaluate the results of the application of the Doppler-guided transanal hemorrhoidal dearterialization technique plus hemorrhoidopexy in patients with grades II and III hemorrhoidal disease.
Methods: A descriptive, longitudinal and prospective study was carried out in patients with grades II and III hemorrhoidal disease, operated on at Hospital Clínico-Quirúrgico Hermanos Ameijeiras, in the period between January 2020 and January 2022. The sample consisted of 14 patients who underwent hemorrhoidal dearterialization plus hemorrhoidopexy. The sample size was limited by the COVID-19 pandemic. Descriptive statistical techniques such as mean and standard deviation were used.
Results: Then male sex predominated, accounting for 57.1 %; the mean age was 44.7 ± 2.9 years. Patients reported symptoms of 2.1 years and were classified as grades II and III, 50.0 % corresponding to each. All patients reported bleeding. The most ligated arterial branch was that of position 3, accounting for 23.8 % of the patients. Postoperative pain, of mild intensity, was present in 12 patients (85.7 %). Good postoperative outcomes were obtained in 92.8 % of those operated on, who expressed to be satisfied.
Conclusions: Doppler-guided hemorrhoidal dearterialization plus hemorrhoidopexy is a feasible technique for treating grades II and III hemorrhoidal disease, with good postoperative outcomes and patient satisfaction, due to rapid incorporation to work and social life.
Downloads
References
Higuero T, Abramowitz L, Castinel A, Pigot F, Pillant-Le Moult H, Senéjoux A, et al. Guidelines for the treatment hemorrhoids (short report). J ViscSurg. 2016;153(3):213-8. DOI: https://doi.org/10.1016/j.jviscsurg.2016.03.004
Davis B, Lee-Kong S, Migaly J, Feingold D, Steele S. The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Hemorrhoids. Dis Colon Rectum. 2018;61(3):284-92. DOI: https://doi.org/10.1097/DCR.0000000000001030
Tournu G, Abramowitz L, Couffignal C, Juguet F, Sénéjoux A, Berger S, et al. Prevalence of anal symptoms in general practice: a prospective study. BMC Fam Pract. 2017;18(1):78. DOI: https://doi.org/10.1186/s12875-017-0649-6
Giamundo P. Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids. World J Gastrointest Surg. 2016;8(1):1-4. DOI: https://doi.org/10.4240/wjgs.v8.i1.1
Brown S, Tiernan J, Watson A, Biggs K, Shephard N, Wailoo A, et al. Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial. Lancet. 2016;388(10042):356-64. DOI: https://doi.org/10.1016/S0140-6736(16)30584-0
van Tol R, van Zwietering E, Kleijnen J, Melenhorst J, Stassen L, Dirksen C, et al. Towards a core outcome set for hemorrhoidal disease-a systematic review of outcomes reported in literature. Int J Colorectal Dis. 2018;33(7):849-56. DOI: https://doi.org/10.1007/s00384-018-3046-2
van Tol R, Melenhorst J, Dirksen C, Stassen L, Breukink S. Protocol for the development of a Core Outcome Set (COS) for hemorrhoidal disease: an international Delphi study. Int J Colorectal Dis. 2017;32(7):1091-4. DOI: https://doi.org/10.1007/s00384-017-2833-5
Lee M, Morgan J, Watson A, Jones G, Brown S. A validated severity score for haemorrhoids as an essential prerequisite for future haemorrhoid trials. Tech Coloproctol. 2019;23(1):33-41. DOI: https://doi.org/10.1007/s10151-019-01936-9
Ratto C, Campennì P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017;21(12):953-62. DOI: https://doi.org/10.1007/s10151-017-1726-5
Tradi F, Louis G, Giorgi R, Mege D, Bartoli J, Sielezneff I, et al. Embolization of the Superior Rectal Arteries for Hemorrhoidal Disease: Prospective Results in 25 Patients. J VascIntervRadiol. 2018;29(6):884-92. DOI: https://doi.org/10.1016/j.jvir.2018.01.778
Emile S, Elfeki H, Sakr A, Shalaby M. Management of acute uncomplicated diverticulitis without antibiotics: a systematic review, meta-analysis, and meta-regression of predictors of treatment failure. Tech Coloproctol. 2018;22(7):499-509. DOI: https://doi.org/10.1007/s10151-018-1817-y
Giarratano G, Toscana E, Toscana C, Petrella G, Shalaby M, Sileri P. Transanal Hemorrhoidal Dearterialization Versus Stapled Hemorrhoidopexy: Long-Term Follow-up of a Prospective Randomized Study. SurgInnov. 2018;25(3):236-41. DOI: https://doi.org/10.1177/1553350618761757
Tsunoda A, Takahashi T, Kusanagi H. A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids. TechColoproctol. 2017;21(8):657-65. DOI: https://doi.org/10.1007/s10151-017-1673-1
Hoyuela C, Carvajal F, Juvany M, Troyano D, Trias M, Martrat A, et al. HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up. Int J Surg. 2016;28:39-44. DOI: https://doi.org/10.1016/j.ijsu.2016.02.030
Kunitake H, Poylin V. Complications Following Anorectal Surgery. Clin Colon Rectal Surg. 2016;29(1):14-21. DOI: https://doi.org/10.1055/s-0035-1568145
Xu L, Chen H, Gu Y. Stapled Hemorrhoidectomy Versus Transanal Hemorrhoidal Dearterialization in the Treatment of Hemorrhoids: An Updated Meta-Analysis. Surg Laparosc Endosc Percutan Tech. 2019;29(2):75-81. DOI: https://doi.org/10.1097/SLE.0000000000000612
Rørvik H, Styr K, Ilum L, McKinstry G, Dragesund T, Campos A, et al. Hemorrhoidal Disease Symptom Score and Short Health ScaleHD: New Tools to Evaluate Symptoms and Health-Related Quality of Life in Hemorrhoidal Disease. Dis Colon Rectum. 2019;62(3):333-42. DOI: https://doi.org/10.1097/DCR.0000000000001234
Asociación Médica Mundial. Declaración de Helsinki de la AMM-Principios éticos para las investigaciones médicas en seres humanos; 2024 [acceso 10/02/2022]:9. Disponible en: https://conbioetica-mexico.salud.gob.mx/descargas/pdf/Declaracion_ Helsinki_Brasil.pdf
Cruz-Coke M. Declaración Universal de Bioética y Derechos Humanos de la UNESCO. Rev. méd. Chile. 2005 [acceso 11/08/2023];133(9):1120-2. Disponible en: https://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872005000900019&lng=es.http://dx.doi.org/10.4067/S0034-98872005000900019
CIOMS & WHO (2016). International Ethical Guidelines for Health-related Research Involving Humans, Fourth Edition. 2016. Geneva. Retrieved March 22; 2017 [acceso 01/03/2022]. Disponible en: https://cioms.ch/ethical-guidelines-2016/WEB-CIOMS-EthicalGuide lines.pdf
Pico R. La Ética en el Sector de la salud. Rev. Cub. Tecnol. Salud. 2015 [acceso 21/08/2023];6(3). Disponible en: https://revtecnologia.sld.cu/index.php/tec/article/view/483
Ferrari L, Jamier I, Barrionuevo M, García D. Análisis y resultados de la operación de Ferguson en el tratamiento de la enfermedad hemorroidal. Rev Argent Coloproct. 2013 [acceso 21/08/2023];24(2):85-9. Disponible en: https://docs.bvsalud.org/biblioref /2024 /02/442045/analisis-y-resultados-de-la-operacion-de-ferguson-en-el-tratami_CU LomEh.pdf
Wexner S, Fleshman J. Colon and Rectal Surgery Anorectal Operations. 2 Ed. Philadelphia USA: Wolters Kluwer; 2019 [acceso 03/08/2023]. Disponible en: https://www.amazon.com/Colon-Rectal-Surgery-Operations-Techniques-book/dp/B07 B2ZZTC4
Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017;21(5):337-44. DOI: https://doi.org/10.1007/s10151-017-1620-1
Leung A, Cheung T, Tung K, Tsang Y, Cheung H, Lau C, et al. A prospective randomized controlled trial evaluating the short-term outcomes of transanal hemorrhoidal dearterialization versus tissue-selecting technique. Tech Coloproctol. 2017;21(9):737-43. DOI: https://doi.org/10.1007/s10151-017-1669-x
Parello A, Litta F, De Simone V, Campennì P, Orefice R, Marra A, et al. Haemorrhoidal haemodynamic changes in patients with haemorrhoids treated using Doppler-guided dearterialization. BJS. 2021;5(2):zrab012. DOI: https://doi.org/10.1093/bjsopen/zrab012
Cantero R, Balibrea J, Ferrigni C, Sanz M, García J, Pérez R, et al. Desarterialización hemorroidal transanal guiada por Doppler. Una alternativa en el tratamiento de las hemorroides [Doppler-guided transanal haemorrhoidal dearterialisation. An alternative treatment for haemorrhoids]. Cir Esp. 2008;83(5):252-5. DOI: https://doi.org/10.1016/s0009-739x(08)70563-3
Rørvik H, Campos A, Styr K, Ilum L, McKinstry G, Brandstrup B, et al. Minimal Open Hemorrhoidectomy Versus Transanal Hemorrhoidal Dearterialization: The Effect on Symptoms: An Open-Label Randomized Controlled Trial. Dis Colon Rectum. 2020;63(5):655-67. DOI: https://doi.org/10.1097/DCR.0000000000001588
Giamundo P, Braini A, Calabro' G, Crea N, De Nardi P, Fabiano F, et al. Doppler-guided hemorrhoidal dearterialization with laser (HeLP): a prospective analysis of data from a multicenter trial. Tech Coloproctol. 2018;22(8):635-43. DOI: https://doi.org/10.1007/s10151-018-1839-5
Downloads
Published
How to Cite
Issue
Section
License
Aquellos autores/as que tengan publicaciones con esta revista, aceptan los términos siguientes:
- Los autores/as conservarán sus derechos de autor y garantizarán a la revista el derecho de primera publicación de su obra, el cuál estará simultáneamente sujeto a la Licencia de reconocimiento de Creative Commons que permite a terceros compartir la obra siempre que se indique su autor y su primera publicación esta revista.
- Los autores/as podrán adoptar otros acuerdos de licencia no exclusiva de distribución de la versión de la obra publicada (p. ej.: depositarla en un archivo telemático institucional o publicarla en un volumen monográfico) siempre que se indique la publicación inicial en esta revista.
- Se permite y recomienda a los autores/as difundir su obra a través de Internet (p. ej.: en archivos telemáticos institucionales o en su página web) antes y durante el proceso de envío, lo cual puede producir intercambios interesantes y aumentar las citas de la obra publicada. (Véase El efecto del acceso abierto).
