Health Problem: Hemorrhoids are enlarged and/or symptomatic venous cushions in the rectum and anus. They are composed of clusters of vascular tissue, smooth muscle, and connective tissue. Symptomatic hemorrhoids are thought to develop when their supporting tissues deteriorate, causing abnormal downward displacement of the anal cushions and venous dilation. They can cause pain, bleeding, and discomfort that, if untreated, may worsen or lead to thrombosis.
Technology Description: Transanal hemorrhoidal dearterialization (THD) employs an anoscope or proctoscope combined with a Doppler transducer and light source to aid in the location of the terminal branches of the hemorrhoidal arteries and enable physicians to tie them off with sutures to decrease blood flow to the symptomatic hemorrhoid.
Controversy: There are many surgical procedures used to treat hemorrhoids when conservative measures are inadequate. Whether THD is more effective or less harmful than other procedures for the treatment of hemorrhoids requires evidence-based evaluation.
Key Questions: Relevant questions regarding THD include:
- How does the efficacy of THD compare with alternative procedures for treating hemorrhoids, including closed hemorrhoidectomy, open hemorrhoidectomy, stapled hemorrhoidopexy, suture ligation, and rubber band ligation?
- Do patients have less postoperative pain or shorter recuperation after THD?
- How does the safety of THD compare with these alternative procedures for hemorrhoid treatment, including operative complications and other safety concerns?
- Have definitive patient selection criteria been established for THD?
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