What you hear is the sound of the arterial inflow or the blood flow going into the hemorrhoid. So, with THD we try to find that hemorrhoid and tie it off after we’ve lifted it up. So, I’ve placed the first stitch now and you can no longer hear the artery pulsating because it’s been effectively ligated or tied off and the blood flow has been occluded. The next step will be then to simply do what we call the pexy portion of the procedure whereby we lift the hemorrhoid up and put it back to where it began so that the patients no longer experience prolapse, or a falling out of the hemorrhoid.
In order to do that, I’m going to remove the roof or the channel. Now I can directly see the hemorrhoid and I’m going to sew it back into its position where it began. This requires approximately four to six stitches and at the conclusion of the placing of the stitches, I’ll be able then to tie the stitches and effectively pull the tissue back inside. If that completes the first one, we simply put the instrumentation back together and go onto the next hemorrhoidal group.
The second group is actually larger than the first. And again, there’s a cessation of blood flow when I tie the stitch and the arterial blood flow into the hemorrhoid which is a artery and a vein, has not stopped. And similar to the first hemorrhoid, we will simply replace this hemorrhoid back to where it originated. Let’s go ahead and remove the roof.
It’s always interesting that the room becomes very quiet after the blood has stopped flowing to the hemorrhoid as opposed to the loud whooshing sound that you hear while the blood is flowing into the hemorrhoid. The theory behind this procedure is that the technology allows us to place our stitches in precise locations to simply occlude the blood flow without taking extra tissue. Our results today have been very good.
One of the main differences between THD and PPH is that in a PPH once the instrument is inserted, tissue is actually removed. There are many circumstances where this has to be performed, but one of the advantages of THD is that no tissue is removed. However, THD is not applicable to all case nor is PPH. Patient’s selection is very important and the operation needs to be tailored and individualized given each patient’s clinical situation and anatomy.
The arterial inflow on this side is less strong corresponding to this hemorrhoid being slightly smaller. The THD, because each area is treated separately, takes a little bit longer than the PPH. Again, it’s just the nature of the procedure and not a benefit or a lack of benefit. And again, each procedure is performed individualizing it to the patient. However, the issue is not necessarily speed, the issue is adequacy of the operation.
By calling one of the board certified surgeons of Los Angeles Colon and Rectal Surgical Associates at (310)273-2310, you can find which hemorrhoidal treatment best fits your clinical situation.