Experience of transanal hemorrhoidal dearterialization in the surgical treatment of grades II-IV hemorrhoids that bleeding

Abstract

The aim of the work was to analyze the use of Transanal Hemorrhoidal Dearterialization (THD) in the surgical treatment of hemorrhoids of various degrees. The use of THD for complicated hemorrhoids in 514 patients for the period 2008–2021 was analyzed on the clinical basis of the Department of Surgery No.3 of the Bogomolets National Medical University (Ukraine). The average age of the patients was 39.1 years. 159 (30.9%) patients had grade II hemorrhoid, 299 (58.2%) – grade III, 56 (10.9%) – grade IV. All patients had manifestations of rectal bleeding and periodic prolapse of hemorrhoidal nodes, 75 (14.6%) patients had a pain syndrome associated with anal fissures, 19 (3.7%) patients underwent THD for recurrent (after performing other operations) hemorrhoids. No severe postoperative complications were observed. The average length of stay in the hospital was 1.3 days. The working capacity of the patients was restored after 3–5 days. Since 2015, THD has been performed according to the method updated by the authors, which was called Distal Doppler-controlled Dearterialization (DDD). We compared the results of performed THD before and after supplementing her DDD. When comparing THD before and after supplementing its DDD, a significant (p=0.00007) increase in the specific gravity of surgical interventions in stage III hemorrhoids while preserving the quality and duration of the postoperative course was revealed. Also, the number of THD in combination with surgery for chronic anal fissure, the number of operations for recurrent hemorrhoids increased significantly (p<0.05), which indicates the validity and effectiveness of the technique as an operation of choice in the surgical treatment of stage II–IV hemorrhoids. Application of the updated technique using DDD facilitates the performance of mucopexy, allows performing operations at later stages of complicated hemorrhoids. Keywords: proctology, THD, DDD, Doppler-controlled dearterialization.