Transanal Hemorrhoidal Dearterialization (THD)
New Hemorrhoid Treatment Minimizes Pain, Discomfort
Hemorrhoids, or piles, is a condition that occurs when the veins around the anus become swollen and inflamed, usually due to frequent constipation or straining while moving bowels. Other risk factors include pregnancy, age and frequent diarrhea.
“As many as half of Americans experience hemorrhoidal problems to some degree,” notes Trinity Health General Surgeon Gary L. Wease, MD, FACS. “About 60 percent of those cases involve symptoms that range from mild to severe. The most common symptoms are bleeding, persistent pain, and a problem with cleanliness.”
Dr. Wease is the first surgeon in the region to offer a new hemorrhoid treatment called Transanal Hemorrhoidal Dearterialization. THD is a minimally-invasive, relatively painless procedure for people with hemorrhoids severe enough to warrant surgical intervention.
“To determine if someone is a candidate for THD we use a standard four-point classification system that grades hemorrhoids according to their stage of development,” Dr. Wease added.
Grade 1:Internal hemorrhoids that bleed
Grade 2:Hemorrhoids that bleed and at times prolapse (protrude outside the anus), but retract spontaneously
Grade 3:Hemorrhoids that are prolapsed and have to be retracted manually
Grade 4:Prolapsed hemorrhoids in which no manual retraction is possible
“Grades 1 and 2 can be treated with topical creams or suppositories that contain hydrocortisone or other ingredients that constrict the blood vessels and decrease the swelling to some degree,” Dr. Wease explained, citing Preparation H as one such ointment. “Dietary counseling to add more fiber can be effective with early-stage hemorrhoids, along with urging people not to strain. People with grades 3 and 4 hemorrhoids are generally candidates for surgical intervention.”
Historically, surgery has consisted of excising the inflamed tissue – a painful procedure that involves three or more weeks of recovery. Alternative approaches have included tying off the swollen hemorrhoidal tissue with a rubber band, or burning it with an electrical charge. “Neither of these approaches provides a permanent solution because they preserve the arterial blood flow which feeds the hemorrhoid,” Dr. Wease noted. “THD, on the other hand, does provide a permanent fix in most cases.”
THD uses a specially patented anoscope with several innovative features. One is a Doppler guidance system that uses ultrasound tones to locate each of the six rectal arteries that feed the hemorrhoid. Another feature lets the surgeon ligate or tie off each individual vessel to stop the blood flow to the hemorrhoid, causing it to shrink. Finally, the system has the ability to grab the entire hemorrhoidal structure and lift it back into the rectum. The outpatient procedure is performed in the O.R. under general anesthesia and takes only about 30 minutes. Dr. Wease says the ingenuity of the system and that fact that it’s easy to master has made it his “go-to” method for hemorrhoid treatment.
“I was most interested in its benefits for patients,” Dr. Wease stated. “There is minimal pain, shorter recovery time, and the patient is able to return to work more quickly. Also, it’s a permanent solution because it eliminates the blood flow to the hemorrhoid. Based on my experience, there are no major complications, and patients have been very happy with the results.”