Transanal Hemorrhoidal Dearterialization (THD) — an Effective Minimally Invasive Technique for the Treatment of Chronic Hemorrhoids

Abstract

Relevance. Hemorrhoids remain one of the most common rectal pathologies, affecting approximately 12% of the population, with 40% of all rectal disease cases attributed to it. In Ukraine, traditional surgical interventions dominate, accounting for 97% of treatments, whereas in the USA and EU countries, minimally invasive techniques comprise up to 83% of cases. Objective. To evaluate the effectiveness of Transanal Hemorrhoidal Dearterialization (THD), specifically the rate of postoperative complications and recurrences. Materials and Methods. From 2007 to 2021, 1,629 THD procedures were performed at the Proctology Department of the Kyiv Regional Clinical Hospital in patients aged 21–73 years (mean age — 37.6 years). Of these, 77.3% had stage III hemorrhoids, 12.7% — stage IV, and 10% — stage II. The procedure was performed using the THD Evolution device (GF s.r.l., Italy) by ligating branches of the superior rectal artery under Doppler guidance, with mucosal pexy conducted to correct mucosal prolapse. Results. Only 7.4% of patients required narcotic analgesics in the early postoperative period. Documented complications included: wound infection (0.2%), profuse bleeding (0.6%), and node thrombosis (6.8%). The overall recurrence rate was 4%. Recurrence management included vacuum ligation (26.2%), classical hemorrhoidectomy (12.3%), or local excision of hemorrhoidal nodes and skin tags (61.5%). Conclusions. The THD technique has proven to be an effective alternative to both traditional and minimally invasive approaches in hemorrhoid treatment. It combines radicality with minimal invasiveness, shortens the postoperative recovery period, and allows for simultaneous treatment of concomitant anal fissures.

Keywords

• hemorrhoids
• dearterialization
• mucopexy
• hemorrhoidal artery
• prolapse
• recurrence