Evaluation of transanal hemorrhoidal dearterialisation (THD)-mucopexy as a successful treatment for stage IV haemorrhoids: a prospective, observational study and a literature review

Introduction:
Currently, transanal hemorrhoidal dearterialisation (THD) is considered the gold-standard therapy for symptomatic grade II-III haemorrhoids.

Aim:
Our objective was to evaluate the efficacy and safety of THD-mucopexy for the management of grade IV haemorrhoids, with a focus on postoperative complications and recurrence rates.

Material and methods:
A total of 37 patients presenting symptomatic grade IV haemorrhoids were enrolled between 2011 and 2014. Thirty-one patients underwent THD-mucopexy, while an additional Milligan-Morgan haemorrhoidectomy with ligation was performed on 6 patients due to excessive tissue prolapse and fibrosis.

Results:
The average procedure duration was 37 ±5 min. Within the entire study cohort, 28 patients noted complete or significant improvement in their symptoms (75.68%), while the remaining 9 participants encountered postoperative complications or disturbances (24.32%). The most severe reported complications were severe pain and postoperative bleeding (5.41%). Among the 7 patients with mild complications (18.92%), issues included tenesmus (10.82%), urinary retention (8.11%), mild regional discomfort (10.82%), and moderate pain (5.41%). The mean hospitalisation duration was 2.14 days. The recurrence rate was 2.7%, with no recorded mortality. Importantly, haemorrhoidal reduction was successfully achieved in all patients.

Conclusions:
Despite the limited supportive literature evidence, THD-mucopexy is recommended as an effective and safe minimally invasive surgical option for the management of stage IV haemorrhoids. It offers the advantage of less postoperative pain along with low complication and recurrence rates. Further research is needed to strengthen these findings and establish THD-mucopexy as a viable option for grade IV haemorrhoids.