Skip to main content
SpringerLink
Log in

Anorectal Functional Outcomes Following Doppler-Guided Transanal Hemorrhoidal Dearterialization: Evidence from Vietnam

  • Original Research
  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Introduction

Doppler-guided transanal hemorrhoidal dearterialization (THD) was considered a less invasive and innovative method to treat hemorrhoidal disease, but it may impact the anal area during dearterialization and mucopexy. Thus, this study aimed to assess any changes in anorectal manometry of grade III and IV hemorrhoidal patients following THD treatment.

Methods

This prospective observational study was conducted with patients who had grades III and IV hemorrhoidal disease. The patients were treated using THD at the Department of Surgery in the National Hospital of Traditional Medicine (Hanoi, Vietnam) between June 2012 and December 2013. Anorectal manometry was performed prior to THD and again between 6 and 12 months following the procedure.

Results

A total of 40 patients were enrolled in the study, including 32 with grade III hemorrhoids and 8 with grade IV hemorrhoids. The proportion of male patients (65%) was higher than that of female patients (35%), and the majority of patients (82.5%) were > 40 years old. The mean duration of symptoms prior to treatment was 12.3 years. The mean length of the anal sphincter was unchanged before and after THD (3.64 ± 0.40 cm prior to treatment vs. 3.66 ± 0.48 cm following treatment; p = 0.57). Significant differences in treatment-related changes were detected for all anorectal manometric measurements except maximum squeezing pressure (p < 0.05). No patient showed anal stenosis or fecal incontinence.

Conclusion

The THD technique did not change the length of the anal sphincter 6 months after hemorrhoid treatment. The values of anal pressure and rectal sensation decreased almost significantly between treatment and the follow-up visit. We suggest that further studies, which include larger sample sizes, should be conducted to confirm THD effectiveness in terms of anorectal functions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Ratto C. THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol. 2014;18(3):291–8.

    Article  CAS  Google Scholar 

  2. Ratto C, de Parades V. Doppler-guided ligation of hemorrhoidal arteries with mucopexy: a technique for the future. J Visc Surg. 2015;152(2 Suppl):S15–21.

    Article  CAS  Google Scholar 

  3. Figueiredo MN, Campos FG. Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: technical evolution and outcomes after 20 years. World J Gastrointest Surg. 2016;8(3):232–7.

    Article  Google Scholar 

  4. Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S. Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Colorectal Dis. 2014;16(5):373–6.

    Article  CAS  Google Scholar 

  5. LaBella GD, Main WP, Hussain LR. Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience. Tech Coloproctol. 2015;19(3):153–7.

    Article  CAS  Google Scholar 

  6. Giamundo P. Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids. World J Gastrointest Surg. 2016;8(1):1–4.

    Article  Google Scholar 

  7. Trenti L, Biondo S, Galvez A, Bravo A, Cabrera J, Kreisler E. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes. Tech Coloproctol. 2017;21(5):337–44.

    Article  CAS  Google Scholar 

  8. Cuong LM, Ha TT, Anh NN, Thanh NT, Kien VD, Lam ND. Comparison of Doppler-guided transanal hemorrhoidal dearterialization for grade III and IV hemorrhoids in Vietnam. Adv Ther. 2019;36(6):1388–97.

    Article  CAS  Google Scholar 

  9. Ratto C, Campenni P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol. 2017;21(12):953–62.

    Article  Google Scholar 

  10. Haskins IN, Holzmacher J, Obias V, Agarwal S. The use of transanal hemorrhoidal dearterialization for treatment of hemorrhoid disease at a single institution. Am Surg. 2016;82(12):1160–2.

    PubMed  Google Scholar 

  11. Ratto C, Parello A, Donisi L, Litta F, Doglietto GB. Anorectal physiology is not changed following transanal haemorrhoidal dearterialization for haemorrhoidal disease: clinical, manometric and endosonographic features. Colorectal Dis. 2011;13(8):e243–5.

    Article  CAS  Google Scholar 

  12. Walega P, Romaniszyn M, Kenig J, Herman R, Nowak W. Doppler-guided hemorrhoid artery ligation with recto-anal-repair modification: functional evaluation and safety assessment of a new minimally invasive method of treatment of advanced hemorrhoidal disease. Sci World J. 2012;2012:324040.

    Article  Google Scholar 

  13. Wanga SK, Lemeshow S. Sample size determination in health studies. A practical manual Ginebra. Geneva, Switzerland: World Health Organization; 1991.

    Google Scholar 

  14. Goligher JC. Surgery of the anus, rectum and colon. 4th ed. London, UK: Bailliere Tindall; 1980. p. 924–5.

    Google Scholar 

  15. Ratto C, Donisi L, Parello A, Litta F, Zaccone G, De Simone V. ‘Distal Doppler-guided dearterialization’ is highly effective in treating haemorrhoids by transanal haemorrhoidal dearterialization. Colorectal Dis. 2012;14(11):e786–9.

    Article  CAS  Google Scholar 

  16. Xu L, Chen H, Lin G, Ge Q, Qi H, He X. Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Tech Coloproctol. 2016;20(12):825–33.

    Article  CAS  Google Scholar 

  17. Hoyuela C, Carvajal F, Juvany M, Troyano D, Trias M, Martrat A, et al. HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after 2-year follow-up. Int J Surg. 2016;28:39–44.

    Article  Google Scholar 

  18. Tsunoda A, Takahashi T, Kusanagi H. A prospective randomized trial of transanal hemorrhoidal dearterialization with mucopexy versus ultrasonic scalpel hemorrhoidectomy for grade III hemorrhoids. Tech Coloproctol. 2017;21(8):657–65.

    Article  CAS  Google Scholar 

  19. Bharucha AE, Rao SS. An update on anorectal disorders for gastroenterologists. Gastroenterology. 2014;146(1):37–45.

    Article  Google Scholar 

  20. Wald A, Bharucha AE, Cosman BC, Whitehead WE. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol. 2014;109(8):1141–57.

    Article  Google Scholar 

  21. Bharucha AE. Difficult defecation: difficult problem assessment and management; what really helps? Gastroenterol Clin N Am. 2011;40(4):837–44.

    Article  Google Scholar 

  22. Bharucha AE, Fletcher JG, Harper CM, Hough D, Daube JR, Stevens C, et al. Relationship between symptoms and disordered continence mechanisms in women with idiopathic faecal incontinence. Gut. 2005;54(4):546–55.

    Article  CAS  Google Scholar 

  23. Rao SS. Pathophysiology of adult fecal incontinence. Gastroenterology. 2004;126:S14–22.

    Article  Google Scholar 

  24. Hong YK, Choi YJ, Kang JG. Correlation of histopathology with anorectal manometry following stapled hemorrhoidopexy. Ann Coloproctol. 2013;29(5):198–204.

    Article  Google Scholar 

  25. Noelting J, Ratuapli SK, Bharucha AE, Harvey DM, Ravi K, Zinsmeister AR. Normal values for high-resolution anorectal manometry in healthy women: effects of age and significance of rectoanal gradient. Am J Gastroenterol. 2012;107(10):1530.

    Article  Google Scholar 

  26. Li Y, Yang X, Xu C, Zhang Y, Zhang X. Normal values and pressure morphology for three-dimensional high-resolution anorectal manometry of asymptomatic adults: a study in 110 subjects. Int J Colorectal Dis. 2013;28(8):1161–8.

    Article  Google Scholar 

  27. Lee H, Jung K, Han S, Kim J, Park SK, Yoon I, et al. Normal values for high-resolution anorectal manometry/topography in a healthy Korean population and the effects of gender and body mass index. Neurogastroenterol Motil. 2014;26(4):529–37.

    Article  CAS  Google Scholar 

  28. Coss-Adame E, Rao SS, Valestin J, Ali-Azamar A, Remes-Troche JM. Accuracy and reproducibility of high-definition anorectal manometry and pressure topography analyses in healthy subjects. Clin Gastroenterol Hepatol. 2015;13(6):1143–50.

    Article  Google Scholar 

  29. Lee TH, Bharucha AE. How to perform and interpret a high-resolution anorectal manometry test. J Neurogastroenterol Motil. 2016;22(1):46–59.

    Article  Google Scholar 

  30. Azpiroz F, Enck P, Whitehead WE. Anorectal functional testing: review of collective experience. Am J Gastroenterol. 2002;97(2):232–40.

    PubMed  Google Scholar 

  31. Prichard D, Harvey DM, Fletcher JG, Zinsmeister AR, Bharucha AE. Relationship among anal sphincter injury, patulous anal canal, and anal pressures in patients with anorectal disorders. Clin Gastroenterol Hepatol. 2015;13(10):1793–800.

    Article  Google Scholar 

  32. Leroi A-M, Berkelmans I, Denis P, Hémond M, Devroede G. Anismus as a marker of sexual abuse. Dig Dis Sci. 1995;40(7):1411–6.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank the patients and healthcare professionals who participated in this study.

Funding

No funding or sponsorship was received for this study or publication of this article. The journal’s rapid service fee was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Disclosures

The authors Le Manh Cuong, Vu Nam, Tran Thai Ha, Tran Thu Ha, Tran Quang Hung, Do Van Loi, Tran Manh Hung, Nguyen Van Son and Vu Duy Kien have nothing to disclose.

Compliance with Ethics Guidelines

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Military Medical University committee, Vietnam, and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. Approval to conduct the study was obtained from the committee of the Military Medical University, Vietnam, by the Decision no. 2858/QD-HVQY. Informed consent was obtained from all individual participants included in the study.

Data Availability

The datasets generated during and/or analyzed during the current study are available in the Figshare repository, https://doi.org/10.6084/m9.figshare.11342642.

Author information

Authors and Affiliations

  1. National Hospital of Traditional Medicine, Hanoi, Vietnam

    Le Manh Cuong, Vu Nam, Tran Thai Ha, Tran Thu Ha & Tran Quang Hung

  2. National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam

    Do Van Loi

  3. Bach Mai hospital, Hanoi, Vietnam

    Tran Manh Hung

  4. Phu Tho Provincial General Hospital, Viet Tri, Phu Tho, Vietnam

    Nguyen Van Son

  5. OnCare Medical Technology Company Limited, Hanoi, Vietnam

    Vu Duy Kien

Authors
  1. Le Manh Cuong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vu Nam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tran Thai Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tran Thu Ha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tran Quang Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Do Van Loi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tran Manh Hung
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Nguyen Van Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vu Duy Kien
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Le Manh Cuong.

Additional information

Enhanced Digital Features

To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.11605455.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cuong, L.M., Nam, V., Ha, T.T. et al. Anorectal Functional Outcomes Following Doppler-Guided Transanal Hemorrhoidal Dearterialization: Evidence from Vietnam. Adv Ther 37, 1136–1144 (2020). https://doi.org/10.1007/s12325-020-01238-9

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12325-020-01238-9

Keywords

Search

Navigation