Transarterial Hemorrhoidal Dearterialization (THD)

Medically reviewed by: Gary H. Hoffman, MD

Hemorrhoids.  Pesky Symptoms.

Hemorrhoids are a bane of adult life.  Hemorrhoids, those pieces of protruding tissue that many patients feel around the anal opening, can be associated with pesky and irritating symptoms.  The list of symptoms is long and the treatments are relatively few.  Treatments range from medications to surgery, with each step along the treatment path slightly more intrusive.

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Hemorrhoids are nothing more than normal body tissue gone awry.  Hemorrhoids are composed of arteries, veins, nerves and connective tissue.  They exist in the anal canal and serve to cushion the stool as it passes outward.  Hemorrhoids are normal.  However, when they enlarge, they produce symptoms.  It is not known whether hemorrhoidal disease is caused by excess pressure in the arteries delivering blood to the area, or a weakness in the veins, which remove blood from the area.

Internal, External.  Different Locations.  Different Symptoms.

Internal hemorrhoids are located above the dentate line in the anal canal.  The dentate line is an anatomic landmark.  Above this line, there are few classical pain fibers and this is why internal hemorrhoids are relatively painless.  This is an important point in treatment, especially surgical treatment.

External hemorrhoids are located below the dentate line and have an abundance of pain fibers.  This too is important in surgical treatment.

THD.  Transarterial Hemorrhoidal Dearterialization.

When all non-surgical remedies have failed, and when a proctologist (also known as a coloproctologist or colon and rectal surgeon) recommends surgical therapy, there are several choices.  The choices include PPH (the Procedure for Prolapse and Hemorrhoids), THD (Transarterial Hemorrhoidal Dearterialization) and an traditional surgical excision (hemorrhoidectomy)

A THD is performed at an outpatient facility under anesthesia.  A special anoscope is inserted into the anal canal.  Using a Doppler ultrasound probe to enable the surgeon to actually hear the whooshing of arterial blood in each hemorrhoid, a stitch is placed through each hemorrhoidal artery, thus depriving it of its blood supply.  The stitch is placed above the dentate line, where there are few pain fibers.  Hence, less postoperative pain.  The theory is that the hemorrhoid will then simply involute (shrivel up).

Following this, a suture (stitch) is used to elevate the prolapsing (protruding) tissue back into its normal place in the anal canal.  Patients then return home on the same day.

THD is not for use in the treatment of external hemorrhoids.  However, in treating the internal hemorrhoids, the external hemorrhoids may actually be returned to the anal canal and may resolve.

THD.  The Advantages.

Advantages of THD are:

  • Less postoperative pain.
  • A faster return to the activities of daily life
  • A quicker return to work
  • Less blood loss compared with a traditional hemorrhoidectomy.
  • Less use of postoperative pain medication.

Los Angeles Colon and Rectal Surgical Associates

In Los Angeles, Beverly Hills and Culver City, there are skilled proctologists available to help you.  At Los Angeles Colon and Rectal Surgical Associates, each surgeon is board certified and specially trained in all aspects of care for diseases of the colon, rectum and anus.  An appointment with one of the surgeons will allow you to ask questions and begin the road to treatment of your hemorrhoids.  (310)273-2310.

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