THD (Transanal hemoroid deterializasyon) Ameliyatı?

THD yani transanal hemoroidal deterializasyon ameliyatı hemoroidleri tedavi etmek için kullanılan ve minimal düzeyde doku tahrişi yapılan bir cerrahi prosedürdür.

THD Nedir?

THD, hemoroid boyutunu küçültmek için kan sağlayan damarların dikilmesidir. Ayrıca bazen hemoroid ligasyonu, droppler kılavuzlu ligasyon ve hemoroid arter ligasyonu olarak ta adlandırılır.

THD Kimler İçin Uygundur?

Hemoroid teşhisine bağlı olarak eğer hemoroid dereceniz 2., 3. veya 4. derece hemoroid teşhisi konduysa doktorunuz veya danışmanınız ameliyat önerdiyese THD sizin için uygun olabilir.

THD İşlemleri Nedir?

THD işlemleri sırasında, hemoroide kan sağlayan ana damar arterleri, bir ultrason probu ile maksimum hassasiyet sağlayan ince, özel olarak tasaralnamış bir proktoskop  ile özenle yerleştirilir. Bu damarların her biri daha sonra prosktoskopun küçük bir çalışma alanından nazikçe dikilir.

Hemoroid memelerinin sarkması durumunda (genelde 3. ve 4. derece hemoroidler) tüm dikişlerin dentat çizginin üstünde taklasına dikkat edilerek, sarkmış olan yığınlara birkaç dikişli hareketli bir dikiş uygulanır. Asıl amaç mukozanın rektal duvarın derin katmanlarına daha sıkı yapışmasıdır.

THD işlemleri, diğer ameliyat tekniklerden aşağıdaki şekillerde farklılık gösterir:

 

  • Atardamarları bulmak, dikmek ve sarkmış yığınlara ince dikişler uygulamak için aynı ince aleti kullanır, böylece alet küçük pencereden çalışırken her zaman aynı pozisyonda kalır ve prosedürü son derece nazik ve güvenli hale getirir.
  • Hemoroidli dokuyu kesmez veya çıkarmaz, bu nedenle ameliyat sonrası komplikasyonlar diğer normal ameliyatlara kıyasla önemli ölçüde azalır.
  • Kan sağlayan arterler lastik bantlarla (hemoroid bantlamada olduğu gibi) bağlanmadığından, dikildiğinden, THD prosedürü çok daha az ameliyat sonrası komplikasyon ve daha iyi uzun vadeli sonuçlarla ilişkilendirilmiştir.
  • Geleneksel ameliyat türlerine kıyasla düşük tekrarlama oranları nedeniyle, THD prosedürü Avrupa çapında çok sayıda hastanede benimsenmiştir.

THD Ameliyatı Sonrası?

İşlem dentat çizginin üzerindeki bölgede (duyu sinirlerinin olmadığı bir bölge) yapıldığından işlem sırasında veya sonrasında herhangi bir dikiş hissetmezsiniz.

Ancak bazı hastalar daha sonra makat bölgesinde hafif bir rahatsızlık hissedebilir ve bu rahatsızlık genellikle birkaç gün içinde kaybolur. Herhangi bir sarkma dikildiyse, bazı hastalar hafif bir dışkılama dürtüsü hissedebilir. Bu onarılan prolapsusla ilgilidir ve yavaş yavaş da ortadan kalkacaktır.

Çoğu durumda, hastalar 24-48 saat içinde normal aktivitelerine devam ederler.

Özetle

Sonuç olarak, ek bir prosedürün bu riski artırabileceği ve yaşam kalitesini etkileyebileceği durumlarda, bu teknik daha önce anal cerrahi ve dışkılama sorunları olan hastalar için mükemmel bir seçenek olabilir. Ayrıca, THD tekniği sık postoperatif morbidite, yaşamı tehdit eden komplikasyonlar veya ciddi sekeller ile ilişkilendirilmemiştir.

 

REFERANSLAR:

  1. Aigner F, Bonatti H, Peer S et al (2010) Vascular considerations for stapled haemorrhoidopexy. Color Dis 12:452–458CrossRefGoogle Scholar
  2. Atallah S, Maharaja GK, Martin-Perez B, Burke JP, Albert MR, Larach SW (2016) Transanal hemorrhoidal dearterialization (THD): a safe procedure for the anticoagulated patient? Tech Coloproctol 20:461–466PubMedPubMedCentralCrossRefGoogle Scholar
  3. Avital S, Itah R, Skornick Y, Greenberg R (2011) Outcome of stapled hemorrhoidopexy versus doppler-guided hemorrhoidal artery ligation for grade III hemorrhoids. Tech Coloproctol 15(3):267–271PubMedCrossRefGoogle Scholar
  4. Avital S, Inbar R, Karin E, Greenberg R (2012a) Five-year follow-up of Doppler-guided hemorrhoidal artery ligation. Tech Coloproctol 16:61–65PubMedCrossRefGoogle Scholar
  5. Avital S, Inbar R, Karin E, Greenberg R (2012b) Five-year follow-up of Doppler-guided hemorrhoidal artery ligation. Tech Coloproctol 16(1):61–65PubMedCrossRefGoogle Scholar
  6. Béliard A, Labbé F, de Faucal D, Fabreguette JM, Pouderoux P, Borie F (2014) A prospective and comparative study between stapled hemorrhoidopexy and hemorrhoidal artery ligation with mucopexy. J Visc Surg 151(4):257–262PubMedCrossRefGoogle Scholar
  7. Bursics A, Morvay K, Kupcsulik P, Flautner L (2004) Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Color Dis 19(2):176–180CrossRefGoogle Scholar
  8. Chauhan A, Thomas S, Bishnoi PK, Hadke NS (2007) Randomized controlled trial to assess the role of raised anal pressures in the pathogenesis of symptomatic early hemorrhoids. Dig Surg 24(1):28–32PubMedCrossRefGoogle Scholar
  9. Conaghan P, Farouk R (2009) Doppler-guided hemorrhoid artery ligation reduces the need for conventional hemorrhoid surgery in patients who fail rubber band ligation treatment. Dis Colon Rectum 52(1):127–130PubMedCrossRefGoogle Scholar
  10. Dal Monte PP, Tagariello C, Sarago M et al (2007) Transanal haemorrhoidal dearterialisation: nonexcisional surgery for the treatment of haemorrhoidal disease. Tech Coloproctol 11:333–338PubMedCrossRefGoogle Scholar
  11. Denoya P, Tam J, Bergamaschi R (2014a) Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial. Tech Coloproctol 18(11):1081–1085PubMedPubMedCentralCrossRefGoogle Scholar
  12. Denoya P, Tam J, Bergamaschi R (2014b) Hemorrhoidal dearterialization with mucopexy versus hemorrhoidectomy: 3-year follow-up assessment of a randomized controlled trial. Tech Coloproctol 18(11):1081–1085PubMedPubMedCentralCrossRefGoogle Scholar
  13. Elmér SE, Nygren JO, Lenander CE (2013) A randomized trial of transanal hemorrhoidal dearterialization with anopexy compared with open hemorrhoidectomy in the treatment of hemorrhoids. Dis Colon Rectum 56(4):484–490PubMedCrossRefGoogle Scholar
  14. Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y (2011) Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum 54(2):226–231PubMedCrossRefGoogle Scholar
  15. Faucheron JL, Voirin D, Abba J (2012) Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Br J Surg 99(6):746–753PubMedCrossRefGoogle Scholar
  16. Festen S, van Hoogstraten MJ, van Geloven AA, Gerhards MF (2009) Treatment of grade III and IV haemorrhoidal disease with PPH or THD. A randomized trial on postoperative complications and short-term results. Int J Color Dis 24(12):1401–1405CrossRefGoogle Scholar
  17. Figueiredo MN, Campos FG (2016) Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: technical evolution and outcomes after 20 years. World J Gastrointest Surg 8(3):232–237PubMedPubMedCentralCrossRefGoogle Scholar
  18. Giamundo P (2016) Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids. World J Gastrointest Surg 8(1):1–4PubMedPubMedCentralCrossRefGoogle Scholar
  19. Giordano P, Overton J, Madeddu F, Zaman S, Gravante G (2009) Transanal hemorrhoidal dearterialization: a systematic review. Dis Colon Rectum 52(9):1665–1671PubMedCrossRefGoogle Scholar
  20. Giordano P, Nastro P, Davies A, Gravante G (2011) Prospective evaluation of stapled haemorrhoidopexy versus transanal haemorrhoidal dearterialisation for stage II and III haemorrhoids: three-year outcomes. Tech Coloproctol 15(1):67–73PubMedPubMedCentralCrossRefGoogle Scholar
  21. Giordano P, Tomasi I, Pascariello A, Mills E, Elahi S (2014) Transanal dearterialization with targeted mucopexy is effective for advanced haemorrhoids. Color Dis 16(5):373–376CrossRefGoogle Scholar
  22. Gupta PJ, Kalaskar S, Taori S, Heda PS (2011) Doppler-guided hemorrhoidal artery ligation does not offer any advantage over suture ligation of grade 3 symptomatic hemorrhoids. Tech Coloproctol 15:439–444PubMedCrossRefGoogle Scholar
  23. Hiltunen KM, Matikainen M (1985) Anal manometric findings in symptomatic hemorrhoids. Dis Colon Rectum 28(11):807–809PubMedCrossRefGoogle Scholar
  24. Hussein AM (2001) Ligation-anopexy for treatment of advanced hemorrhoidal disease. Dis Colon Rectum 44(12):1887–1890PubMedCrossRefGoogle Scholar
  25. Infantino A, Bellomo R, Dal Monte PP, Salafia C, Tagariello C, Tonizzo CA et al (2010) Transanal haemorrhoidal artery echodoppler ligation and anopexy (THD) is effective for II and III degree haemorrhoids: a prospective multicentric study. Color Dis 12(8):804–809CrossRefGoogle Scholar
  26. Jayaraman S, Colquhoun PH, Malthaner RA (2007) Stapled hemorrhoidopexy is associated with a higher long-term recurrence rate of internal hemorrhoids compared with conventional excisional hemorrhoid surgery. Dis Colon Rectum 50:1297–1305PubMedCrossRefGoogle Scholar
  27. Khafagy W, El Nakeeb A, Fouda E et al (2009) Conventional haemorrhoidectomy, stapled haemorrhoidectomy, Doppler guided haemorrhoidectomy artery ligation; post operative pain and anorectal manometric assessment. Hepato-Gastroenterology 56:1010–1015PubMedGoogle Scholar
  28. LaBella GD, Main WP, Hussain LR (2015) Evaluation of transanal hemorrhoidal dearterialization: a single surgeon experience. Tech Coloproctol 19(3):153–157PubMedPubMedCentralCrossRefGoogle Scholar
  29. Liu H, Yang C, Chen B, Wu J, He H (2015) Clinical outcomes of Doppler-guided haemorrhoidal artery ligation: a meta-analysis. Int J Clin Exp Med 8(4):4932–4939PubMedPubMedCentralGoogle Scholar
  30. Lucarelli P, Picchio M, Caporossi M, De Angelis F, Di Filippo A, Stipa F et al (2013) Transanal haemorrhoidal dearterialisation with mucopexy versus stapler haemorrhoidopexy: a randomised trial with long-term follow-up. Ann R Coll Surg Engl 95(4):246–251PubMedPubMedCentralCrossRefGoogle Scholar
  31. Lucha PA (2009) Pathophysiology of hemorrhoidal disease. In: Khubchandani I, Paonessa N, Azimuddin K (eds) Surgical treatment of hemorrhoids. Springer, London, pp 15–17CrossRefGoogle Scholar
  32. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 90(4):610–613PubMedGoogle Scholar
  33. Ortiz H, Marzo J, Armenda’riz P, De Miguel M (2005) Stapled hemorrhoidopexy vs. diathermy excision for fourth-degree hemorrhoids: a randomized, clinical trial and review of the literature. Dis Colon Rectum 48:809–815PubMedCrossRefGoogle Scholar
  34. Patti R, Almasio PL, Arcara M, Sparacello M, Termine S, Bonventre S et al (2007) Long-term manometric study of anal sphincter function after hemorrhoidectomy. Int J Color Dis 22(3):253–257CrossRefGoogle Scholar
  35. Poylin V (2016) Anal physiology: the physiology of continence and defecation. In: Steele SR, Hull TL, Read TE, Saclarides TJ, Senagore AJ, Whitlow CB (eds) The ASCRS textbook of colon and rectal surgery, 3rd edn. Springer, New York, pp 37–44Google Scholar
  36. Ratto C (2014) THD Doppler procedure for hemorrhoids: the surgical technique. Tech Coloproctol 18(3):291–298PubMedCrossRefGoogle Scholar
  37. Ratto C, de Parades V (2015) Doppler-guided ligation of hemorrhoidal arteries with mucopexy: a technique for the future. J Visc Surg 152(2 Suppl):S15–S21PubMedCrossRefGoogle Scholar
  38. Ratto C, Donisi L, Parello A, Litta F, Doglietto GB (2010) Evaluation of transanal hemorrhoidal dearterialization as a minimally invasive therapeutic approach to hemorrhoids. Dis Colon Rectum 53(5):803–811PubMedCrossRefGoogle Scholar
  39. Ratto C, Parello A, Donisi L, Litta F, Doglietto GB (2011a) Anorectal physiology is not changed following transanal haemorrhoidal dearterialization for haemorrhoidal disease: clinical, manometric and endosonographic features. Color Dis 13(8):e243–e245CrossRefGoogle Scholar
  40. Ratto C, Giordano P, Donisi L, Parello A, Litta F, Doglietto GB (2011b) Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids. Tech Coloproctol 15(2):191–197PubMedCrossRefGoogle Scholar
  41. Ratto C, Parello A, Donisi L, Litta F, Zaccone G, Doglietto GB (2012) Assessment of haemorrhoidal artery network using colour duplex imaging and clinical implications. Br J Surg 99:112–118PubMedCrossRefGoogle Scholar
  42. Ratto C, Parello A, Veronese E, Cudazzo E, D’Agostino E, Pagano C et al (2015a) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Color Dis 17(1):O10–O19CrossRefGoogle Scholar
  43. Ratto C, Parello A, Veronese E, Cudazzo E, D’Agostino E, Pagano C, Cavazzoni E, Brugnano L, Litta F (2015b) Doppler-guided transanal haemorrhoidal dearterialization for haemorrhoids: results from a multicentre trial. Color Dis 17(1):O10–O19CrossRefGoogle Scholar
  44. Sajid MS, Parampalli U, Whitehouse P, Sains P, McFall MR, Baig MK (2012) A systematic review comparing transanal haemorrhoidal de-arterialisation to stapled haemorrhoidopexy in the management of haemorrhoidal disease. Tech Coloproctol 16(1):1–8PubMedCrossRefGoogle Scholar
  45. Satzinger U, Feil W, Glaser K (2009) Recto anal repair (RAR): a viable new treatment option for high-grade hemorrhoids. One year results of a prospective study. Pelviperineology 28:37–42Google Scholar
  46. Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191(1):89–93PubMedCrossRefGoogle Scholar
  47. Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102(13):1603–1618PubMedCrossRefGoogle Scholar
  48. Theodoropoulos GE, Sevrisarianos N, Papaconstantinou J, Panoussopoulos SG, Dardamanis D, Stamopoulos P et al (2010) Doppler-guided haemorrhoidal artery ligation, rectoanal repair, sutured haemorrhoidopexy and minimal mucocutaneous excision for grades III-IV haemorrhoids: a multicenter prospective study of safety and efficacy. Color Dis 12(2):125–134CrossRefGoogle Scholar
  49. Tsang YP, Fok KL, Cheung YS, Li KW, Tang CN (2014) Comparison of transanal haemorrhoidal dearterialisation and stapled haemorrhoidopexy in management of haemorrhoidal disease: a retrospective study and literature review. Tech Coloproctol 18(11):1017–1022PubMedCrossRefGoogle Scholar
  50. Verre L, Rossi R, Gaggelli I, Di Bella C, Tirone A, Piccolomini A (2013) PPH versus THD: a comparison of two techniques for III and IV degree haemorrhoids. Personal experience. Minerva Chir 68(6):543–550PubMedGoogle Scholar
  51. Walega P, Romaniszyn M, Kenig J, Herman R, Nowak W (2012) Doppler-guided hemorrhoid artery ligation with recto-anal-repair modification: functional evaluation and safety assessment of a new minimally invasive method of treatment of advanced hemorrhoidal disease. Sci World J 2012:324040CrossRefGoogle Scholar
  52. Wilkerson PM, Strbac M, Reece-Smith H, Middleton SB (2009) Doppler-guided haemorrhoidal artery ligation: long-term outcome and patient satisfaction. Color Dis 11(4):394–400CrossRefGoogle Scholar
  53. Xu L, Chen H, Lin G, Ge Q, Qi H, He X (2016) Transanal hemorrhoidal dearterialization with mucopexy versus open hemorrhoidectomy in the treatment of hemorrhoids: a meta-analysis of randomized control trials. Tech Coloproctol 20:825–833. [Epub ahead of print]PubMedCrossRefGoogle Scholar
/tarafından