THD and mucopexy: Efficacy and controversy

Abstract Aims Transanal haemorrhoidal dearterialisation and mucopexy has evolved in recent years as a popular minimally invasive non-excisional surgery for symptomatic prolapsing haemorrhoids. The long-term outcome of this procedure however, remains to be established. We aim to analyse the long-term outcome of THD-mucopexy in the management of prolapsing haemorrhoids based on the evidence of a prospective data from a single institution. Methods A prospective data was collected on 100 consecutive cases of grade 3 and 4 symptomatic haemorrhoids between the period 03/2010 and 06/2015 who underwent the procedure as a day case under general anaesthetic. Overall median follow up was for two years with average age of 54.4 ranges from 34 to 79 and gender ratio of 61% Male and 39% Female. Pre-and postoperative symptoms were assessed with a view to evaluate the nature of complications and long-term recurrence rate. Results Preop Post op (6 weeks) Post op (6 months) P value Bleeding 74 (74%) 9 9 P Prolapse 31 (31%) 6 7 P Perianal pain 15 (15%) 3 2 P = 0.006 Discharge 5 (5%) 1 0 P = 0.21 Itching 2 (2%) 0 0 P = 0.47 Anal fissure (Healed) 4 (4%) 0 4 P = 0.71 Postoperative complications Bleeding 7 (7%) Pain 5 (5%) Urgency 1 (1%) Fistula 1 (1%) Discharge 2 (2%) Infection 3 (3%) Recurrence rate– 13 (13%) Conclusion THD mucopexy is a safe and effective minimally invasive modality for prolapsing symptomatic haemorrhoids with acceptable complication rates and a recurrence rate of 13% majority of which could be dealt with a repeat procedure. Long terms follow up and randomised (THD VS Haemorrhoidectomy) multicentre trials are warranted to compare its efficacy with that of conventional excisional surgery.