Editorial
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2016; 8(1): 1-4
Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.1
Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids
Paolo Giamundo
Paolo Giamundo, Department of General Surgery, Hospital Santo Spirito, 12042 Bra, Italy
Author contributions: Giamundo P had performed the literature research and written the manuscript.
Conflict-of-interest statement: Giamundo P is a surgical trainer for Biolitec Italia, Milan, Italia. No fees were received to write this editorial.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Paolo Giamundo, MD, FEBSQ, FRCS Eng, Chief of Colorectal Surgery Service-ASL CN-Region Piemonte, Department of General Surgery, Hospital Santo Spirito, Via Vittorio Emanuele, 3, 12042 Bra, Italy. pgiamundo@gmail.com
Telephone: +39-33-32603400
Received: August 21, 2015
Peer-review started: August 24, 2015
First decision: September 30, 2015
Revised: October 9, 2015
Accepted: November 24, 2015
Article in press: November 25, 2015
Published online: January 27, 2016
Abstract

In the last two decades, hemorrhoidal dearterialization has become universally accepted as a treatment option for symptomatic hemorrhoids. The rationale for this procedure is based on the assumption that arterial blood overflow is mainly responsible for dilatation of the hemorrhoidal plexus due to the absence of capillary interposition between the arterial and venous systems within the anal canal. Dearterialization, with either suture ligation (Doppler-guided hemorrhoid artery ligation/transanal hemorrhoidal dearterialization) or laser (hemorrhoidal laser procedure), may be successfully performed alone or with mucopexy. Although the added value of Doppler-guidance in association with dearterialization has recently been challenged, this imaging method still plays an important role in localizing hemorrhoidal arteries and, therefore, minimizing the effect of anatomic variation among patients. However, it is important to employ the correct Doppler transducer. Some Doppler transducers may not easily detect superficial arteries due to inadequate frequency settings. All techniques of dearterialization have the advantage of preserving the anatomy and physiology of the anal canal, when compared to other surgical treatments for hemorrhoids. This advantage cannot be underestimated as impaired anal function, including fecal incontinence and other defecation disorders, may occur following surgical treatment for hemorrhoids. Furthermore, this potentially devastating problem can occur in patients of all ages, including younger patients.

Keywords: Dearterialization, Laser dearterialization, Hemorrhoids, Mucopexy

Core tip: This editorial analyzes the techniques of dearterialization for hemorrhoids. The advantages and pitfalls of the various techniques of dearterialization are reported, with specific attention given to the role of Doppler ultrasound and technical tips on the various procedures. Finally, the author reports the efficacy of dearterialization based on data in the literature as well as personal experience in this field.