Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.1
Peer-review started: August 24, 2015
First decision: September 30, 2015
Revised: October 9, 2015
Accepted: November 24, 2015
Article in press: November 25, 2015
Published online: January 27, 2016
Processing time: 153 Days and 0.4 Hours
In the last two decades, hemorrhoidal dearterialization has become universally accepted as a treatment option for symptomatic hemorrhoids. The rationale for this procedure is based on the assumption that arterial blood overflow is mainly responsible for dilatation of the hemorrhoidal plexus due to the absence of capillary interposition between the arterial and venous systems within the anal canal. Dearterialization, with either suture ligation (Doppler-guided hemorrhoid artery ligation/transanal hemorrhoidal dearterialization) or laser (hemorrhoidal laser procedure), may be successfully performed alone or with mucopexy. Although the added value of Doppler-guidance in association with dearterialization has recently been challenged, this imaging method still plays an important role in localizing hemorrhoidal arteries and, therefore, minimizing the effect of anatomic variation among patients. However, it is important to employ the correct Doppler transducer. Some Doppler transducers may not easily detect superficial arteries due to inadequate frequency settings. All techniques of dearterialization have the advantage of preserving the anatomy and physiology of the anal canal, when compared to other surgical treatments for hemorrhoids. This advantage cannot be underestimated as impaired anal function, including fecal incontinence and other defecation disorders, may occur following surgical treatment for hemorrhoids. Furthermore, this potentially devastating problem can occur in patients of all ages, including younger patients.
Core tip: This editorial analyzes the techniques of dearterialization for hemorrhoids. The advantages and pitfalls of the various techniques of dearterialization are reported, with specific attention given to the role of Doppler ultrasound and technical tips on the various procedures. Finally, the author reports the efficacy of dearterialization based on data in the literature as well as personal experience in this field.