Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2016; 8(3): 232-237
Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.232
Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years
Marleny Novaes Figueiredo, Fábio Guilherme Campos
Marleny Novaes Figueiredo, Department of Gastroenterology, University of São Paulo Medical School, São Paulo, PC 01411-000, Brazil
Fábio Guilherme Campos, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, PC 01411-000, Brazil
Author contributions: Both authors performed research and wrote the paper.
Conflict-of-interest statement: None of the authors have any conflict of interest.
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:
Correspondence to: Fábio Guilherme Campos, MD, PhD, Associate Professor of Surgery, Colorectal Surgery Division Staff Surgeon, Department of Gastroenterology, Hospital das Clínicas, University of São Paulo Medical School, Rua Padre João Manoel, 222 - Cj 120 - Cerqueira César, São Paulo, PC 01411-000, Brazil.
Telephone: +55-11-30610108 Fax: +55-11-30610108
Received: August 29, 2015
Peer-review started: September 7, 2015
First decision: December 7, 2015
Revised: December 19, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: March 27, 2016

In the setting of Hemorrhoidal Disease treatment, the option of conventional hemorrhoidectomy is highly effective, but it is still associated with postoperative pain and discomfort. For this reason, technical alternatives have been developed in order to reduce complications and to provide better postoperative recovery. To accomplish this aim, non-excisional techniques such as stapled hemorrhoidectomy and Doppler-guided hemorrhoidal ligation have been introduced into clinical practice with high expectations. The aim of this article is to revise the literature about transanal hemorrhoidal dearterialization technique in the treatment of hemorrhoidal disease, looking into its evolution, results and possible benefits over other modalities of surgical treatment. The literature review showed that Doppler-guided hemorrhoidal dearterialization is a safe and effective method to treat grades II to IV hemorrhoidal disease. Outcomes in patients presenting prolapse are satisfactory and the association of anopexy is an important aspect of this operation. Anal physiology disturbances are rarely observed and mainly transitory. This technique is an excellent option for every patient, especially in those with previous anal surgeries and in patients with previous alterations of fecal continence, when an additional procedure might represent a risk of definitive incontinence.

Keywords: Doppler-guided hemorrhoidal dearterialization, Hemorrhoids, Transanal hemorrhoidal dearterialization

Core tip: Management of hemorrhoidal disease is a tough task. First of all, because there are some technical alternatives that should be adequately indicated to different patients; secondly, because patients desire a good alternative associated with low morbidity, good long-term results and less postoperative pain. In this setting, the transanal hemorrhoidal dearterialization (THD) technique is considered a safe and effective choice for internal hemorrhoids of grades II to IV. The present paper reviews technical aspects and literature results of THD in comparison to other operative techniques.