Transanal Hemorrhoidal Dearterialization Versus Conventional Hemorrhoidectomy For The Treatment Of Hemorrhoids

Abstract

Background: Hemorrhoidal disease is a prevalent anorectal condition. Traditional hemorrhoidectomy is considered the gold standard for advanced cases but is associated with considerable postoperative pain. Transanal Hemorrhoidal Dearterialization (THD) has emerged as a minimally invasive alternative with promising outcomes. Objective: To compare the clinical outcomes, postoperative complications, and recurrence rates between THD and conventional hemorrhoidectomy in the management of symptomatic hemorrhoids. Patient and Methods: A retrospective cohort comparative study was conducted on 200 patients with symptomatic hemorrhoidal disease who underwent either THD (n=100) or CH (n=100). Parameters assessed included operative time, postoperative pain (VAS scores), complication rates, return to work, patient satisfaction at 3 months, and recurrence at 12 months. Results: The THD group demonstrated significantly shorter operative time (32.6 ± 8.7 vs 41.2 ± 9.5 minutes; p < 0.001) and lower postoperative pain on days 1, 3, and 7 (p < 0.001 for all). Total complication rates were significantly lower in the THD group (12% vs 26%; p = 0.01). Patients treated with THD resumed work earlier (5.2 ± 2.1 vs 13.1 ± 4.3 days; p < 0.001) and reported higher satisfaction at 3 months (94% vs 85%; p = 0.03). Although recurrence was slightly higher in the THD group (10% vs 4%; p = 0.04), most cases were mild and managed conservatively. Compared to conventional hemorrhoidectomy, THD offers significant advantages in terms of reduced postoperative pain, lower complication rates, shorter operative time, faster return to work, and higher patient satisfaction. Although the recurrence rate is slightly higher, most of the recurrences are mild and manageable without further surgical intervention. These findings support THD as a valuable and patient-friendly alternative to excisional hemorrhoidectomy, with the added benefit of preserving anorectal anatomy and function. Further prospective, multicenter trials with long-term follow-up are needed to validate these outcomes and refine patient selection criteria. Conclusion: Transanal Hemorrhoidal Dearterialization (THD) is a safe, effective, and minimally invasive surgical technique for the management of symptomatic hemorrhoidal disease, particularly Grades II and III, and selected cases of Grade IV.