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.
| Age | 56.7 (25-80) |
| BMI | (28.22) |
| Gender | 58F (54.3%) 49 M (45.8%) |
| Previous hemorrhoid surgery | 34 (31%): |
| 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.