THD Method
Introduction
In the last few years, thanks to the evolution of new technologies, new procedures have been introduced, which although being resolutive, since they tie the vascular peduncles, do not provoke post-op. pain because they do not require the excision of hemorrhoidal tissue.
The Transanal Hemorrhoidal Dearterialisation (THD), is the least invasive surgical treatment for hemorrhoids.
It utilizes a specially designed instrument, the THD. |
Description
The THD is equipped with a Doppler transducer to locate the terminal branches of the superior rectal artery, which are then ligated, through an apposite slit in the INSTRUMENT, 3 cm. above the dentate line, in an area not sensible to pain. The particular shape of the instrument consents a precise and selective ligation of these arterial branches that supply blood to the hemorrhoids. THD has the distinct advantage of being the only resolutive surgical treatment which can be performed with local anesthesia as a day case or an outpatient procedure. The patient walks out of the office without pain and can resume his normal activity in 24-48 hours. Moreover, in the rare case of partial failure due to incomplete artery ligation, the procedure can be easily repeated.
After ligation of the arteries, the arterial inflow to the piles drops.
However venous outflow is not compromised, thus the ratio of the inflow/outflow decreases, the piles collapse and the eventual bleeding stops. The decreased tension allows for the regeneration of the connective tissue within the cushions.
This facilitates the shrinkage of hemorrhoids and induces permanent reduction of the prolapse.
The sutures used to ligate the arteries create a rectal pexy by simultaneously stitching the rectal mucosa to the layers below and elevating the hemorrhoidal cushions above the dentate line, thus reducing or eliminating the rectal prolapse.
THD results as the most physiological resolutive approach to hemorrhoids since it allows the preservation of those vascular tissues, which Thompson describes as being so important for continence.
For all of the above reasons, we are confident that the widening of the use of this procedure, versus the traditional ones, will also expand the trend towards resolutive approaches to hemorrhoids, since patients will also become progressively less afraid to meet their surgeon. |