Technical Tips and Tricks of Dearterialization of Hemorrhoids and Mucopexy

Abstract

Hemorrhoidal disease is a recurrent anorectal complaint in the surgeon’s office, with a 5% prevalence in general population. Several new techniques and devices have been developed, such as transanal hemorrhoidal dearterialization (THD). THD aims to reduce the hemorrhoidal blood flow through Doppler-guided ligation of the terminal branches of hemorrhoidal arteries and to provide application of the redundant rectal mucosa/submucosa (mucopexy). The surgery is fully performed in the distal rectum, avoiding the somatic innervation of the perianal skin, minimizing postoperative pain and thus providing faster recovery.

Transanal hemorrhoidal dearterialization, as any other surgical technique for hemorrhoids, should be offered to patients with symptomatic hemorrhoidal disease, despite clinical treatment. Patients who most benefit from THD are those with bleeding or prolapsed internal hemorrhoids. Patients whose symptoms are due to skin tags or external hemorrhoids will not benefit just because the technique is performed completely above the dentate line.

No enemas or bowel preparation are done before surgery because too soft or liquid stools can run through the anal canal making visualization difficult. Both general and spinal anesthesia are safe and effective for hemorrhoid surgery.

To perform the dearterialization, an “X-stitch” is performed at the place of the Doppler signal at the six main hemorrhoidal arteries branches.

To perform the mucopexy, using a conventional needle holder, it is performed a nonanchored continuous suture, involving mucosa and submucosa distally to the place where the dearterialization was performed.