Transanal hemorrhoidal dearterialization (THD) is a surgical procedure for the treatment of internal hemorrhoids. Internal hemorrhoids can be described as varicose veins inside the rectum. These veins become inflamed and enlarged and can interfere with bowel movement. They can also prolapse, falling out of the anus, needing to be gently pushed back in. THD cuts off the arterial blood flow to the hemorrhoids so they shrink and excess tissue eventually dies. In the United States, these procedures are usually day surgery, with the patient going home from the recovery room.
THD isn't really a new procedure. An early variation of it was used as long as 60 years ago. The advantage of the newer version of the procedure is that it uses "radar" to detect arterial blood flow. A cylindrical suturing device is inserted into the anus, and the Doppler detects blood flow. The surgeon uses the probe to suture the artery in two different places, and the Doppler confirms that the sutures (which will eventually dissolve) are in the right place. It usually takes six or seven sutures to stop blood flow to the hemorrhoid. If the hemorrhoid is large or prolapsed, the surgeon may also perform a procedure called a hemorrhoidopexy. In this procedure, the surgeon staples a ring of the lining of the rectum to pull a hemorrhoid back inside the anus and staples it in place. The staples also interrupt blood flow to the hemorrhoid so it shrinks.
These procedures are considered "minimally invasive."
They involve a lot less cutting than an old-fashioned hemorrhoidectomy. Neither of these minimally invasive procedures requires the removal of tissue. That doesn't mean that recovering from them is pleasant or easy. Post-surgical pain is usually manageable except after a bowel movement. Doctors may given their patients opioid pain relievers such as Vicodin or Oxycontin, and it can also help to take a sitz bath (sitting in warm water over the level of the anus) to relieve soreness. More often than not, recovery is uncomplicated, but about 30 percent of cases involve complications.
- Anal stenosis, a narrowing of the anal canal that interferes with the passage of stool, may show up about four to six weeks after the procedure. It's treated by daily dilation of the anus with an anal dilator by the surgeon who performed the procedure. When this happens, there usually was a problem finding enough tissue to work with so too much tension was placed on the sutures.
- Anal leakage, which is exactly what it sounds like, sometimes happens during the healing process. One has a bowel movement without any warning sensations. Fortunately, this problem typically goes away after the suture sites heal, about six weeks after the surgery.
- Poor wound healing is most often a problem when there is constipation causing straining at bowel movement. It's important to take probiotics that can dissolve fiber, and then to add more fiber (preferably soluble fiber from fruits and vegetables), which in turn makes stools softer. When it's not necessary to strain at bowel movement, the suture sites can heal more quickly.
- About 15 percent of people who have the THD procedure have problems passing urine immediately after the operation. Men who have prostate problems usually will have to have a catheter for a few days.
- Bleeding usually isn't a problem, but patients who look pale or pass out have to go back to the doctor immediately for assessment of internal bleeding.
So, should everyone who has hemorrhoids have THD? The problem with THD is that the results tend not to be permanent. Conventional surgery, which involves cutting out the hemorrhoids, not just interfering with their blood supply, will result in much longer symptom-free periods. THD without Doppler requires a slightly longer initial recovery period (11 days compared to 9), but is much less likely to be complicated by bleeding and pain over the longer term (three to six months after the procedure). THD improves symptoms in the overwhelming majority, 94 percent, of patients who receive it, but up to 93 percent will experience some bleeding, prolapse, or problems with passing urine in the year after the procedure.
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