THD^® Doppler for Anolift: indications

Based on clinical evidence and numerous scientific publications, the THD® Doppler for Anolift procedure is indicated for the surgical treatment of all grades of haemorrhoid disease. ^{1, 2,3,4}

The procedure has proven to be safe and effective for all grades of haemorrhoid disease that do not respond to conservative or outpatient treatments. Depending on the symptoms and the severity of the disease, the surgeon will assess whether to perform only haemorrhoidal artery ligation or dearterialisation with mucopexy.

Bibliography:

1. Transanal Haemorrhoidal Dearterialisation Anolift – prospective assessment of safety and efficacy – Giordano P., Schembari E. – 2021
2. 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
3. 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;
4. 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

THD^® Doppler for Anolift: surgical procedure

The THD^® Doppler for Anolift method has been developed using state-of-the-art technology and the latest medical and scientific research. THD^® Doppler for Anolift surgery effectively treats the causes of haemorrhoid disease by addressing its symptoms.

The THD^® Doppler for Anolift method is a surgical procedure to treat both arterial overflow and haemorrhoidal prolapse. In fact, haemorrhoid disease is linked to hypertension of the haemorrhoidal plexus (vascular element) and degeneration of the connective tissue (mechanical element). Both the vascular and the mechanical elements can be associated with the characteristic symptoms of haemorrhoid disease: bleeding and prolapse.

The aim of the THD^® Doppler for Anolift procedure is to treat the causes of haemorrhoid disease, thereby relieving the related symptoms. This is why the THD^® Doppler for Anolift method involves both dearterialisation and mucopexy.

In fact, haemorrhoidal dearterialisation causes the arterial overflow to the haemorrhoids to be minimised by reducing the terminal branches of the superior rectal artery under guidance with Doppler ultrasound. Mucopexy, on the other hand, aims to return the prolapsed tissue to its original anatomical position by providing support to the connective tissue through scarring.

Surgical Intervention

 

The first step of the procedure is to insert the THD^® Slide proctoscope into the anal canal. Next, the proctoscope is retracted and rotated distally to identify the strongest Doppler signal, which is usually just above the anorectal junction where the artery is shallower and the blood supply is greater. This is the best location to effectively reduce blood flow by means of the dearterialisation procedure (dearterialisation point).

The surgeon then sutures the terminal branch of the artery at the dearterialisation point by inserting the tip of the needle holder into the pivot and performing a Z-suture (Figure 8 knot) to stop the flow of arterial blood.

The procedure is repeated by rotating the proctoscope in the same direction (clockwise or anti-clockwise) up to 6 times (normally 6 arteries are identified and ligated).

After completing the dearterialisation phase, the surgeon repositions the prolapsed tissue: using the THD^® Block suture, the surgeon starts the procedure from the most proximal point of the prolapse and ties the mucous membrane using the “button” of the THD^® Block suture as an anchor point for the mucopexy.

The surgeon gently opens the sliding part of the proctoscope to allow the mucous membrane to enter the proctoscope and performs a continuous suture (5 mm between each suture point) until the anorectal junction is reached, but remaining above it.

This means that the procedure is performed in an area with a smaller number of nerve endings, thus significantly reducing post-operative discomfort.

By gently pulling on the free end of the suture, the surgeon pushes the prolapsed mucous membrane along the rectal wall until the self-locking suture of the THD^® Block returns the prolapsed tissue to its normal position, restoring its original anatomical state. The healing and fibrosis process induced by the mucopexy helps to firmly attach the tissue to the underlying rectal wall.

The surgeon then repeats the mucopexy as needed at the points where the prolapse is most pronounced and removes the proctoscope, taking care to protect the mucopexy.

The THD^® Revolution Doppler generator with integrated LED light source and the THD^® Slide proctoscope have been specially developed for performing the THD^® Doppler for Anolift method.

The procedure can be performed as a day surgery and the patient can be discharged about eight hours after the operation. The surgery takes an average of 30 minutes1 and the patient can typically resume normal activities in 2-3 days².

THD^® Doppler for Anolift: results and advantages

The THD^® Doppler for Anolift procedure has changed the surgical approach to the treatment of haemorrhoid disease, improving the effectiveness of the results and reducing discomfort, invasiveness and pain for the patient.

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

• non-excisional procedure: the procedure does not involve the removal of any tissue.
• minimally invasive procedure that maintains anorectal physiology and the function of the haemorrhoidal cushions. Furthermore, the surgery is performed in an area without nerve endings. These factors result in shorter hospitalisation times, a rapid resumption of normal activities, and less post-operative pain and bleeding.
• wide range of indications: the procedure is suitable for all grades of haemorrhoid disease and has proven to be effective on prolapses and thrombosed haemorrhoids.
• low recurrence rate: the THD® Doppler for Anolift method has a low recurrence rate.
• repeatable: unlike excisional haemorrhoid surgery, this procedure can be repeated several times, as required. 
• no serious complications: no serious post-operative complications have been reported in the literature.

The rapid resumption of everyday activities, the limited post-operative discomfort, the low recurrence rate, the respect for the physiology of the anorectal area, and the high percentage of efficacy and improvement of symptoms are the main reasons for the high patient satisfaction rate. ^1,2,3

Bibliography:

1. Transanal Haemorrhoidal Dearterialisation Anolift – prospective assessment of safety and efficacy – Giordano P., Schembari E. – 2021
2. 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  
3. 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

THD^® Doppler for Anolift: endorsements and clinical evidence

The effectiveness and results of the THD^® Doppler for Anolift method are supported by scientific studies, long-term clinical evidence and endorsements from independent scientific associations and institutions.

NICE Interventional Procedure Guidance

In 2010, the National Institute for Health and Clinical Excellence (NICE) recognised the THD^® Doppler for Anolift procedure as an effective alternative to haemorrhoidectomy or stapled haemorrhoidopexy “Treating Haemorrhoids by Tying Off Their Blood Supply” (IPG342).

Royal College of Surgeons

Since 2015, the Royal College of Surgeons has been accrediting training sessions dedicated to the method.

ASCRS Clinical Practice Guidelines

Recently, the American Society of Colon and Rectal Surgeons (ASCRS) also issued new clinical practice guidelines on the treatment of haemorrhoid disease. ASCRS is a scientific society committed to establishing high standards of healthcare for patients with colorectal disorders based on the most reputable clinical evidence.
In 2018, the ASCRS guidelines included Doppler-guided ligation of haemorrhoidal arteries with mucopexy as one of the surgical treatments for haemorrhoids, based on the review of 28 prospective studies involving a total of 2,904 patients with grade I to IV haemorrhoids.

Clinical evidence and scientific publications

The efficacy of the THD^® Doppler for Anolift procedure is now supported by long-term clinical evidence and reputable scientific studies, which is why it is recognised as an effective and safe surgical method by practitioners all over the world.
Further information on the scientific literature related to the THD^® Doppler for Anolift Method can be found in the Clinical Studies section.