Transanal hemorrhoidal artery ligation

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The Transanal Hemorrhoidal Artery Ligation (THD) is a minimally invasive method that is used to treat 2nd to 3rd and sometimes 4th degree hemorrhoids and symptoms such as bleeding, congestion and edema that are due to strong blood supply to the hemorrhoids relieves.

history

The THD method is a further development of the hemorrhoidal artery ligature developed by Kazumasa Morinaga . In 1995 Morinaga published a paper describing the positive results obtained in hundreds of hemorrhoid patients. These patients had been operated on using a technique that tied off the terminal branches of the arteries supplying the hemorrhoids. The veins, which were located with a Doppler probe applied to a proctoscope , were provided with a ligature which is attached via a window in the proctoscope in front of the Doppler probe.

The further development of the THD method consists in the fact that the Doppler-controlled hemorrhoid desarterialization was combined with a gathering of the prolapsed mucous membrane and hemorrhoid tissue, which is one of the typical symptoms of advanced disease stages (III. To IV. Degree).

execution

In this surgical procedure, a proctoscope with a Doppler probe and a window at its tip is inserted into the rectum . As soon as a branch of the upper hemorrhoidal artery has been located with the aid of the Doppler probe, it is tied through the window with a thread that loops around the artery twice. Then the window is opened wider (the upper part of the proctoscope can be pulled out) so that any incident can be viewed through the opening of the proctoscope. With the same suture material that was used to tie the artery, the herniated tissue is now grasped with the help of some loops and gathered upwards. Two centimeters in front of which is dentate halted, attached so that the gathered web in the non-sensitive region above line and a lifting of the prolapsed mucosa is achieved.

This process is repeated on all six branches of the upper hemorrhoidal artery, relieving the rush of blood and bleeding from the hemorrhoidal cushions and reducing the proliferation of mucous membranes and hemorrhoids.

Postoperative course

Since, if the procedure is carried out correctly, the tissue is neither cut nor removed above the sawtooth line, so there is little or no postoperative pain. Complications occur only rarely, to a limited extent, and can be easily resolved (urinary retention, hematoma , bleeding , thrombosis ). This makes it possible to carry out this operation as a one-day procedure with any type of anesthesia and, for lower grades (II to III degrees), also on an outpatient basis with local anesthesia.

Surgery on hemorrhoids of a higher degree (III.–IV.) can lead to an obsession with bowel movements which, however, quickly disappears and the patient can return to his normal activity within approx. 48 hours.

Special medical treatment is not required, but it is advisable to follow a liquid (2 liters per day) and fiber-rich diet in order to promote the passage of soft stools and to avoid the traumatic passage of hard stool through the anus canal. For example, adopting a high-fiber diet with fruits, vegetables and whole grains and no irritating ingredients such as spices, fried foods and alcohol is the first step in countering milder cases of hemorrhoidal disease in the early stages.

Advantages and disadvantages

Since the THD method is part of minimally invasive surgery, it can also be used in patients with severely debilitating pathologies, with incontinence of the sphincter or after operations with other methods. The procedure is almost painless, as no tissue is removed and the suture is placed above the '' Linea dentata '' (where there are no sensitive nerve endings). Since the normal anatomical condition of the affected areas is restored after a few months, further operations on the anal canal and rectum can be carried out or the patient can resume his normal lifestyle.

Studies have shown that hemorrhoids recur ( relapse ) in only 10% of cases after surgery .

literature

Individual evidence

  1. ↑ K. Morinaga, K. Hasuda, T. Ikeda: A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter . In: American Journal of Gastroenterology . . 90, No. 4, April 1995, pp. 610-613. PMID 7717320 .
  2. ↑ PP Dal Monte, C. Tagariello et al.: Transanal haemorrhoidal dearterialization: nonexcisional surgery for the treatment of haemorrhoidal disease . In: Tech Coloproctol . 11, No. 4, December 2007, pp. 333-338; discussion 338-339. doi : 10.1007 / s10151-007-0376-4 . PMID 18060529 .
  3. ↑ P. Giordano, J. Overton et al.: Transanal hemorrhoidal dearterialization: a systematic review. In: Diseases of the Colon and Rectum . Volume 52, Number 9, September 2009, pp. 1665-1671, ISSN  1530-0358 . doi : 10.1007 / DCR.0b013e3181af50f4 . PMID 19690499 . (Review).
  4. ↑ N. Sohn, JS Aronoff et al: Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. In: The American Journal of Surgery . Volume 182, Number 5, November 2001, pp. 515-519, ISSN  0002-9610 . PMID 11754861 .
  5. ↑ P. Conaghan, R. Farouk: Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery in patients who fail rubber band ligation treatment. In: Diseases of the Colon and Rectum . Volume 52, Number 1, January 2009, pp. 127-130, ISSN  1530-0358 . doi : 10.1007 / DCR.0b013e3181973639 . PMID 19273967 .