Outcomes With Use of Transanal Hemorrhoidal Dearterialization (THD) for Management of Hemorrhoids in a Colon and Rectal Practice

Beth-Ann Shanker, MD, Joseph Gallagher, MD, Andrea Ferrara, MD, Samuel DeJesus, MD, Paul Williamson, MD, Mark Soliman, MD, Renee Mueller, MD. Colon and Rectal Clinic of Orlando

INTRODUCTION: Transanal Hemorrhoidal Dearterialization (THD) is a less invasive technology for treatment of hemorrhoids. THD uses a proctoscope with a Doppler probe to identify branches of the superior hemorrhoidal artery for ligation. We report our outcomes on a series of patients who have undergone this procedure which includes ligation & mucosal pexy of hemorrhoids.

METHODS: This is a retrospective case series of patients who have undergone THD from April of 2012 – July of 2014 at a private practice clinic with 7 board certified colon & rectal specialists. Complications & recurrences are reported.

RESULTS: Over a 27 month period, 920 hemorrhoid procedures were performed. 117 (12.7%) were THD procedures. Data was available on 107 patients.

Characteristics of Patients
Age 56.7 (25-80)
BMI (28.22)
Gender 58F (54.3%) 49 M (45.8%)
Previous hemorrhoid surgery 34 (31%):
Outcomes of THD by Grade of Hemorrhoids & Time Intervals
Grade Complications < 2 weeks Complications 2.1 weeks to 3 months Complications > 3 months
I (5) 1 procitits

1 Bleeding

1 constipation

1 Pruitis

1 Rectal bleeding

II (39)

3 urinary retentions

2 pain

1 drainage

1 N/V

1 constipation

2 Recurrences: (1 RBL)

3 Constipation

3 Rectal bleeding (1 C scope)

1 Pruitis

1 Pain

1 Fecal Incontinence

1 Thrombosed hemorrhoid

2 Recurrence (1 THD, 1 hemorrhoidectomy)

2 Pruitis

2 Rectal bleeding

2 Fecal Incontinence

1 Fissure (LIS)

1 Constipation

1 Levator Spasm

1 Fistula

II/III (15)

1 pain medication refill

1 fever

1 residual skin tag

1 Pain

1 rectal bleeding

1 skin tag removed in office

1 Recurrence (obs)

1 Pruitis

1 Pain

1 Levator Spasm

III (45)

2 urinary retention

2 pain

1 OR for gangrene

1 drainage

1 burning

1 IBS exacerbation

1 dehiscence

1 pressure and swelling

6 Recurrence (1 THD, 3 RBL, 1 Delorme)

2 Pain

2 Rectal bleeding (1 C scope)

1 Constipation

1 Tenesmus

1 Burning

1 Drainage

1 Fissure

1 Thrombosed hemorrhoid

5 Recurrence (2 THD, 3 obs)

2 Fissures

1 Fecal Incontinence

1 Herpes infection

IV (3) 0 0 1 Recurrence

CONCLUSIONS: We present a large retrospective case series of 107 patients who underwent THD. 17 had recurrences (15.7%) and 10 required additional interventions (9.3%). This recurrence rate is on par with other publications. Complications such as bleeding and urinary retention are comparable to other procedures.

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