Transanal hemorrhoidopexy: Why it makes sense

Aim: Transanal open hemorrhoidopexy (TOH) was developed as an alternative to stapled hemorrhoidopexy and THD/mucopexy. The aim of this article is to review the technical aspect and results of this technique. Methods: A single coloproctology center experience with this technique was reviewed retrospectively. All consecutive patients who underwent TOH were analyzed. Short and long-term results are reported. TOH involves placing a Z-suture in the low rectum above the hemorrhoidal cushions and excising a 1 centimeter strip of rectal mucosa between the upper and lower aspects of the suture. Tightening of the suture provides an effective upward life of the hemorrhoidal bundle. The procedure is performed in 3 or 4 quadrants of the anal canal (as needed) at the point of maximal prolapse. Results: From 2006 until 2013, 217 patients with 2nd and 3rd degree internal hemorrhoids were operated. Short-term complications included major bleeding in 5 patients (2%) and severe pain in 19 patients (9%). Long-term follow-up was obtained in 169 of 217 patients (78%) either through clinic visits or phone interview. Available patients were followed up for a minimum period of 60 months after TOH (median 113 months). 109 patients (64%) were symptom free and 147 patients (87%) indicated that they would consent to TOH again. Conclusions: TOH is a safe operation for hemorrhoidal prolapse with encouraging short and long-term results. It is a safe and inexpensive alternative to stapled hemorrhoidopexy or THD/mucopexy and it should be included in the treatment algorithm of patients with symptomatic hemorrhoidal prolapse. (C) 2019 Elsevier Inc. All rights reserved.