Doppler-guided transanal haemorrhoidal dearterialization (THD) for the treatment of symptomatic haemorrhoids: A cohort study

Background and objectives: Haemorrhoids is a common presenting problem to the surgical outpatient. Although open haemorrhoidectomy is an effective procedure, it can lead to significant postoperative pain, narrowing and incontinence. Among many alternative procedures with fewer complications, Transanal Haemorrhoidal dearterialization (THD) with mucopexyis an efficacious and safe alternative with less pain and complications. We aimed to evaluate the outcomes of THD, in terms of complications and recurrence rates, in the treatment of symptomatic haemorrhoids. Methods: this prospective cohort study included all consecutive patients with symptomatic haemorrhoids who underwent THD and rectal mucopexy procedures between January 2013 and December 2022. Patients’ demographics, operative and postoperative data were recorded prospectively. Patients were seen at regular intervals for 60 months. Long-term complications, recurrence and reoperation were recorded during the visits. Microsoft® Excel 2020 and SPSS version 26 was used for data entry and analysis. Results: Eighty-six consecutive patients presented with symptomatic haemorrhoids and underwent THD. The mean age was 41 years, and 80% were men. Rectal bleeding was the most common presenting symptom in 61%, followed by pain and prolapse in 15% and 16%, respectively. Eight per cent of patients presented with strangulated haemorrhoids. Grade III haemorrhoids was the commonest (46.5%). Mean operation time was <30 minutes in 65% of cases. Minor bleeding for 2 days was noticed in 43% of cases after surgery, and minor pain for 3-4 days in 45.3%. Recurrence was noted in 5.8% of cases. The reoperation rate was 2.3%. Conclusion: Data suggest that THD is safe and effective in treating symptomatic haemorrhoids, with low recurrence and reoperation rates.