THD and mucopexy: Efficacy and controversy

•Treatment of Piles with Trans anal Hemorrhoidal De-arterialisation.•Local experience in district hospital prospective cohort study.•Short and long-term complication with recurrence rates.

AimsTransanal 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.MethodsA 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.ResultsPreopPost op (6 weeks)Post op (6 months)P valueBleeding74 (74%)99P<0.0001Prolapse31 (31%)67P<0.0001Perianal pain15 (15%)32P = 0.006Discharge5 (5%)10P = 0.21Itching2 (2%)00P = 0.47Anal fissure (Healed)4 (4%)04P = 0.71Postoperative complicationsBleeding 7 (7%)Pain 5 (5%)Urgency 1 (1%)Fistula 1 (1%)Discharge 2 (2%)Infection 3 (3%)Recurrence rate- 13 (13%)ConclusionTHD 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.