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Highlights from ASCRS Meeting 2011

10 June 2011
THD took part in the Annual Scientific Meeting of The American Society of Colon & Rectal Surgeons (ASCRS) in Vancouver (Canada) 14-18 May 2011 with its own stand and scientific presentations by important research workers. The aim was to favor the meeting of THD and Specialist Proctologists in the common interest of improving knowledge and professional ability.

2011 ASCRS (The American Society of Colon & Rectal Surgeons) Annual Scientific Meeting
Vancouver (Canada) 14th-18th May 2011
www.fascrs.org

The scientific program presented the Specialist Proctologists with the most advanced and up-to-date knowledge on surgery for colon, rectal, and anal diseases with the aim of improving the quality of cures and patient care.
A good deal of exposure was given to hemorrhoidal disease, an area of research in which THD is strongly involved.

• P. De Nardi et al, Ospedale S. Raffaele - Milano, presented the following study:
"Prospective, Randomized Trial on Surgical Treatment of Grade III Hemorrhoids: Hemorrhoidectomy versus Doppler-Guided Transanal Hemorrhoidal Dearterialization and Anopexy".
Between August and October 2010, 30 consecutive patients were randomly assigned to hemorrhoidectomy (Milligan-Morgan) and doppler-guided transanal dearterilization and anopexy (THD).
Authors' conclusions are: "Hemorrhoidal dearterializazion and anopexy showed similar postoperative morbidity and effectiveness as excisional hemorrhoidectomy with minimal postoperative pain, early return of patients to their normal activities and increased patients' satisfaction"

• C. Ratto et al, Università Cattolica - Roma, presented two studies that show the therapeutic effectiveness of THD in the treatment of symptomatic hemorrhoids:

The first one:
"Prospective, Randomized Study Comparing High Ligation vs Low Ligation of Hemorrhoidal Arteries Using THD Procedure in Bleeding Hemorrhoids"
confirms the effectiveness of THD approach in the treatment of bleeding hemorrhoids.
In particular, the "low ligation" of hemorrhoidal arteries (within 1 to 2 cm above the anorectal ring) seems to be superior to the "high ligation" (within 4 to 6 cm above the anorectal ring).
No patient had major postoperative morbidity.

The second study:
"Transanal Hemorhoidal Dearterialization (THD) with Low Ligation of Arteries is Highly Effective in Hemorrhoidal Disease"
involves 50 patients with bleeding hemorrhoids, with or without mucosal hemorrhoidal prolapse, who underwent a THD, using the "low ligation".
At minimum follow-up of 6 months, all patients reported an improvement in symptoms; no patients reported bleeding, fecal incontinence or soiling.

• M.B. Tempel et al, Houston - TX (USA), presented the study:
"A Multicenter Retrospective Analysis Evaluating the Short-Term Efficacy and Safety of Transanal Hemorrhoidopexy with Dearterialization".

216 patients underwent the THD procedure between April 2007 and October 2010 at three geographically diverse surgical centers in the USA (Houston-Utah-Iowa).The average number of days with pain or discomfort was 6.7. The average number of days before return to normal activity was 10.3.
Authors' conclusions are: "Transanal hemorrhoidopexy with dearterialization (THD) is both safe and efficacious. Overall, our patient rate of satisfaction was very high with consistently favorable experiences"

Great attention was also given to Fecal Incontinence, a common problem with a complex physiopathology. Several treatments for the serious forms were presented, for example, the implantation of a magnetic anal sphincter, stimulation of the tibial nerve, and stimulation of the sacral nerve or the pudendal nerve.
On the other hand, Soiling and Fecal Incontinence of medium severity were not discussed, disorders often suppressed by the patient due to the embarrassment caused and the limited therapeutic solutions. Current research is working towards finding an effective answer to this discomfort by using easily applied and very effective surgical methods and instruments.