La THD es una técnica mínimamente invasiva, no excisional que trata hemorroides internas sintomáticas, sobre todo de grados II–III y casos seleccionados de grado IV.

¿En qué consiste y para qué grados se usa?

• Consiste en ligar, bajo guía Doppler, las ramas terminales de la arteria rectal superior y realizar una mucopexia para recolocar el prolapso sin resecar cojinetes hemorroidales (Ratto et al., 2017; Ratto, 2013).
• Es claramente válida y segura para hemorroides grado II–III (Giordano et al., 2009; Sobrado et al., 2020; Verre et al., 2022; Consalvo et al., 2019).
• En grado IV puede emplearse en casos seleccionados (no fibrosos, sin cambios isquémicos), pero con mayor tasa de recurrencia y a menudo se prefiere hemorroidectomía clásica (Giordano et al., 2009; Sobrado et al., 2020; Ratto et al., 2011; Ivanchov & Lissov, 2025).

La THD es una técnica mínimamente invasiva y sin extirpación de tejido eficaz para hemorroides internas grados II–III, con dolor y estancia hospitalaria reducidos. En grado IV puede utilizarse en manos expertas y casos seleccionados, pero la hemorroidectomía sigue ofreciendo menor recurrencia a costa de más dolor y recuperación más lenta.

Referencias bibliografias

References

Ratto, C., Campennì, P., Papeo, F., Donisi, L., Litta, F., & Parello, A. (2017). Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Techniques in Coloproctology, 21, 953 – 962. https://doi.org/10.1007/s10151-017-1726-5

Ivanchov, P., & Lissov, O. (2025). Tactical approaches in the surgical treatment of hemorrhoids – hemorrhoidectomy or transanal hemorrhoidal dearterialization?. Medicine Today and Tomorrow. https://doi.org/10.35339/msz.2025.94.1.ivl

Ratto, C., Donisi, L., Parello, A., Litta, F., & Doglietto, G. (2010). Evaluation of Transanal Hemorrhoidal Dearterialization as a Minimally Invasive Therapeutic Approach to Hemorrhoids. Diseases of the Colon & Rectum, 53, 803-811. https://doi.org/10.1007/dcr.0b013e3181cdafa7

Giordano, P., Overton, J., Madeddu, F., Zaman, S., & Gravante, G. (2009). Transanal Hemorrhoidal Dearterialization: A Systematic Review. Diseases of the Colon & Rectum, 52, 1665-1671. https://doi.org/10.1007/dcr.0b013e3181af50f4

Sobrado, C., Klajner, S., Hora, J., Mello, A., Da Silva, F., Frugis, M., & Sobrado, L. (2020). TRANSANAL HAEMORRHOIDAL DEARTERIALIZATION WITH MUCOPEXY (THD-M) FOR TREATMENT OF HEMORRHOIDS: IS IT APPLICABLE IN ALL GRADES? BRAZILIAN MULTICENTER STUDY. Arquivos Brasileiros de Cirurgia Digestiva : ABCD, 33. https://doi.org/10.1590/0102-672020190001e1504

Ivanchov, P., Lissov, O., & Peresh, Y. (2022). Experience of transanal hemorrhoidal dearterialization in the surgical treatment of grades II-IV hemorrhoids that bleeding. Experimental and Clinical Medicine. https://doi.org/10.35339/ekm.2022.91.2.ilp

Verre, L., Gallo, G., Grassi, G., Bussolin, E., Carbone, L., Poto, G., Samorani, C., Marano, L., Marrelli, D., & Roviello, F. (2022). Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: An Italian single-institution 5-year experience analysis and updated literature review. Frontiers in Surgery, 9. https://doi.org/10.3389/fsurg.2022.1088546

Sobrado, C., Hora, J., Sobrado, L., Frugis, M., Nahas, S., & Cecconello, I. (2020). Transanal hemorrhoidal dearterialization: Lessons learned from a personal series of 200 consecutive cases and a proposal for a tailor-made procedure. Annals of Medicine and Surgery, 55, 207 – 211. https://doi.org/10.1016/j.amsu.2020.05.036

Jee, J., O’Connell, L., Kaur, I., & Sahebally, S. (2024). Conventional Excisional Haemorrhoidectomy versus Transanal Haemorrhoidal Dearterialization for Haemorrhoids: A Systematic Review and Meta-Analysis. Digestive Surgery, 41, 204 – 212. https://doi.org/10.1159/000540256

Ratto, C. (2013). THD Doppler procedure for hemorrhoids: the surgical technique. Techniques in Coloproctology, 18, 291 – 298. https://doi.org/10.1007/s10151-013-1062-3

Emile, S., Elfeki, H., Sakr, A., & Shalaby, M. (2018). Transanal hemorrhoidal dearterialization (THD) versus stapled hemorrhoidopexy (SH) in treatment of internal hemorrhoids: a systematic review and meta-analysis of randomized clinical trials. International Journal of Colorectal Disease, 34, 1-11. https://doi.org/10.1007/s00384-018-3187-3

Ratto, C., Giordano, P., Donisi, L., Parello, A., Litta, F., & Doglietto, G. (2011). Transanal haemorrhoidal dearterialization (THD) for selected fourth-degree haemorrhoids. Techniques in Coloproctology, 15, 191-197. https://doi.org/10.1007/s10151-011-0689-1

Consalvo, V., D’Auria, F., & Salsano, V. (2019). Transanal Hemorrhoidal Dearterialization With Doppler Arterial Identification Versus Classic Hemorrhoidectomy: A Retrospective Analysis of 270 Patients. Annals of Coloproctology, 35, 118 – 122. https://doi.org/10.3393/ac.2017.09.04