The THD® Doppler Method - THDLAB - COM

  • THD® Doppler Method: indications
  • THD® Doppler: surgical procedure
  • THD® Doppler: results and advantages
  • THD® Doppler: acknowledgments and clinical evidence

THD® Doppler Method: indications

Based on clinical evidence and on numerous scientific publications, the THD® procedure is indicated for the surgical treatment of all grades of haemorrhoidal disease. 1, 2,3

The procedure has proved effective and safe for all grades of haemorrhoids that do not respond to conservative and outpatient treatments. Depending on the symptoms and the degree of the disease, the surgeon will evaluate whether to perform only the ligation of the haemorrhoidal arteries or a dearterialisation with mucopexy.

Bibliography:

  1. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature, Ratto C. et al, Tech Coloproct. (2017) 21: 953-962
  2. Distal Doppler-guided transanal hemorrhoidal dearterialization with mucopexy versus conventional hemorrhoidectomy for grade III and IV hemorrhoids: postoperative morbidity and long-term outcomes, Trenti L., Biondo S. et al, Tech Coloproctol. 2017 May;
  3. Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial, Denoya P. et al, Tech Coloproct (2014) 18: 1081-1085
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THD® Doppler: surgical procedure

The THD® Doppler procedure stems from constant research in the clinical field associated with cutting-edge technologies. THD® Doppler surgery allows to effectively treat the causes of haemorrhoidal disease, resolving the symptoms.

The THD® Doppler method is a surgical procedure which enables treatment of both the arterial overflow and of the haemorrhoidal prolapse. The haemorrhoidal disease is in fact connected to hypertension of the haemorrhoidal plexus (vascular component) and to degeneration of the connective tissue (mechanical component). Both the vascular component and the mechanical component can be associated with the characteristic symptoms of the haemorrhoidal pathology: bleeding and prolapse.

The objective of the THD® Doppler procedure is to act on the causes of the haemorrhoidal disease and thus to resolve the symptoms associated with it. This is why the THD® Doppler method involves both dearterialisation and mucopexy.

Transanal haemorrhoidal dearterialisation makes it possible to reduce the arterial hyper-flow to the haemorrhoids through the ligation of the terminal branches of the superior rectal artery under the guide of a Doppler ultrasonography. While the purpose of the mucopexy is to reposition the prolapsed tissue in its original anatomical position by providing support to the connective tissue through scarring.

Procedure

 

During the procedure, the surgeon gently dilates the anus with surgical forceps and inserts the proctoscope deep into the anal canal. Subsequently, the proctoscope is retracted and distally rotated to identify the highest Doppler signal, generally located just above the anorectal junction where the artery is more superficial and the blood supply is greater. This is the most suitable point to effectively reduce blood hyper-flow by means of the dearterialisation procedure. Once identified, the surgeon marks the point of maximum signal (Marker point) using an electrosurgical cutting device or a surgical marking pen.

The surgeon then proceeds to completely reinsert the proctoscope into the anal canal and carries out Z-shaped sutures as anchoring points (Figure 8 knot).

The surgeon gently opens the sliding part of the proctoscope to allow the mucosa to enter the proctoscope and to make a running suture on it until it includes the marker point, remaining in any case above the anorectal junction. In this way the procedure is performed in an area with a small number of nerve endings, allowing a significant reduction in post-operative pain.

By closing the knot, the prolapsed tissue is lifted inside so as to restore the original anatomical condition. The healing and scarring process induced by mucopexy helps to fix the tissue firmly to the underlying rectal wall. The surgeon then removes the proctoscope whilst protecting the mucopexy and repeats the procedure clockwise.

The THD® Revolution Doppler generator with integrated LED light source and the THD® Slide proctoscope are specially designed for the execution of the THD® Doppler method.

The procedure can also be performed in day surgery and the patient can be discharged about 8 hours after the operation. The surgery lasts 30 minutes on average1 and the patient can generally return to the usual activities in 2-3 days2.

Bibliography:

  1. Evaluation of Transanal Hemorroidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorroids, C. Ratto et al., Dis Colon Rectum 2010; 53 (5): 803-811
  2. Dearterializzazione emorroidaria transanale doppler guidata, C. Tagariello et al., Casa di Cura M. F. Toniolo, Villa Erbosa, Bologna, Chirurgia Italiana 2004; Vol. 56 (5): 693-697
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THD® Doppler: results and advantages

The THD® Doppler procedure has modified the surgical approach to treating haemorrhoids, maximising the effectiveness of the results and reducing the discomfort, invasiveness and pain for the patient.

The THD® Doppler method offers long-term results in the treatment of grade II, III and IV haemorrhoidal disease with advantages for the surgeon and patient:

  • non-excisional procedure: the procedure does not require any tissue removal.
  • minimally invasive procedure which preserves the anorectal physiology and the functions of the haemorrhoidal cushions. Furthermore, the operation is performed in an area without nerve endings. These features allow for shorter recovery times, a quick return to normal activities, less pain and post-operative bleeding.
  • extensive indications for the operation: the procedure is indicated for all grades of haemorrhoids and has been shown to be effective on prolapse and thrombosed haemorrhoids.
  • low recurrence rate: the THD® Doppler method has a low recurrence rate.
  • repeatable: unlike excisional haemorrhoidal surgery, this procedure can be repeated multiple times, as needed.
  • no major complications: no post-operative complications are reported in the literature.

A quick return to the usual activities, limited post-operative pain, low recurrence rate, respect for the physiology of the anorectal area and a high percentage of effectiveness and symptom improvement are the main reasons for the high satisfaction rate of patients. 1,2

Bibliography:

  1. Evaluation of Transanal Hemorroidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorroids, C. Ratto et al., Dis Colon Rectum 2010; 53 (5): 803-811
  2. Evaluation of the effectiveness and patients’ contentment with transanal haemorrhoidal artery dearterialisation and mucopexy (THD) for treatment of haemorrhoidal disease: a 6-year study, Qurat Ul Ain et al, Irish Journal of Medical Science, Published online 6° December 2017
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THD® Doppler: acknowledgments and clinical evidence

The efficacy and results of the THD® Doppler method are supported by scientific studies, long-term clinical evidence and acknowledgements by associations and independent scientific institutions.

NICE Interventional Procedure Guidance

In 2010 the National Institute for Health and Clinical Excellence (NICE) recognised the THD® Doppler procedure as an effective alternative to stapled haemorrhoidectomy or haemorrhoidopexyTreating Haemorrhoids by tying off their blood supply” (IPG342).

Royal College of Surgeons

Since 2015, the Royal College of Surgeons has accredited training sessions dedicated to this method.

ASCRS Clinical Practice Guidelines

Recently, the American Society of Colorectal Surgeons (ASCRS) has also issued new guidelines on the clinical practice of treating haemorrhoids. ASCRS is a scientific company committed to defining high levels of health care for patients affected by colorectal disorders, based on the most authoritative clinical evidence.

In 2018, the ASCRS guidelines inserted the Doppler-guided ligation of haemorrhoidal arteries with mucopexy among the surgical treatments of haemorrhoids, based on the review of 28 prospective studies covering a total of 2,904 patients with haemorrhoids from grade I to IV.

Clinical evidence and scientific publications

Today the efficacy of the THD® Doppler procedure is demonstrated by long-term clinical evidence and by authoritative scientific studies: this is why it is recognised as an effective and safe surgical method by professionals all over the world.

Further information on the scientific literature relating to the THD® Doppler method is available in the section Clinical Studies.

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