Scores values tended to decrease postoperatively .
The comparison between haemorrhoidal treatments is still unclear .
Attempts have been made to adopt a unifying postoperative scoring system and thus ensure adequate comparison between clinical trials .
We aim ed to systematic ally review the available outcome scores of haemorrhoidal treatment .
Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids
Background Traditional treatment of fourth-degree haemorrhoidal disease ( HD ) is conventional haemorrhoidectomy and is frequently associated with significant pain and morbidity . In recent years , the use of transanal haemorrhoidal dearterialization ( THD ) for the treatment of HD has increased . The procedure aims to decrease the arterial blood flow to the haemorrhoids . Moreover , since a rectal mucopexy to treat the prolapsing component has become part of the THD technique , this treatment is also indicated for more advanced HD . The aim of this study was to assess the possible role of THD in the treatment of fourth-degree HD . Methods All patients with non-fibrotic fourth-degree HD were offered the THD procedure with mucopexy . Excision of skin tags was added to THD and mucopexy , when needed . A specific score was used to assess HD severity , ranging from 0 ( no HD ) to 20 ( worst HD ) . The mean preoperative score was 18.1 ± 1.8 . Results Thirty-five consecutive patients ( mean age 50.4 ± 13.8 years ; 19 men ) with fourth-degree HD were prospect ively enroled . An average of 6 arteries were identified and transfixed . Mucopexy was achieved with a 3–6 sector plication of rectal mucosa . Mean operating time was 33 ± 12 min . No intraoperative complications were recorded . Postoperative morbidity included 3 ( 8.6 % ) haemorrhoidal thromboses ( 1 requiring surgery ) and 2 ( 5.7 % ) episodes of bleeding ( 1 requiring surgical haemostasis ) . Five patients ( 14.3 % ) had urinary retention requiring catheterization . At a median follow-up of 10 months ( range 2–28 months ) , symptoms had resolved or significantly improved in 33 ( 94 % ) patients . Nine patients ( 25.7 % ) reported irregular bleeding , 3 patients ( 8.6 % ) mild anal pain , 4 patients ( 11.4 % ) transient anal burning and 4 patients ( 11.4 % ) tenesmus . Ten patients ( 28.6 % ) experienced some degree of residual prolapse , significant only in 2 ( 5.7 % ) who required further surgery . There was no anorectal stenosis , and no faecal incontinence was reported . At a median follow-up of 10 months , the symptomatic score was 2.5 ± 2.5 ( P < 0.005 ) . Conclusion Transanal haemorrhoidal dearterialization seems to be a safe and effective treatment for fourth-degree HD providing a significant improvement of symptoms for the majority of patients . When present , persisting symptoms are mostly transient , occasional or limited in severity , and only a very few patients require further intervention . Larger series and longer follow-up to further assess the role of THD in this challenging group of pts
Scores values tended to decrease postoperatively .
The comparison between haemorrhoidal treatments is still unclear .
Attempts have been made to adopt a unifying postoperative scoring system and thus ensure adequate comparison between clinical trials .
We aim ed to systematic ally review the available outcome scores of haemorrhoidal treatment .