The fourth branch of the superior rectal artery and its significance in transanal haemorrhoidal dearterialisation.

ABSTRACT

INTRODUCTION: Transanal haemorrhoidal dearterialisation is a non-excisional surgical method for the treatment of haemorrhoidal disease. It uses a Doppler ultrasound probe to accurately identify the site to suture-ligate the piles, resulting in a decrease in the arterial inflow to the piles and their subsequent regression. METHODS: A total of 140 consecutive patients who underwent transanal haemorrhoidal dearterialisation were studied. The number and locations of the haemorrhoidal arteries were documented. The presenting symptoms and their subsequent resolution were noted. RESULTS: The median number of haemorrhoidal arteries ligated was four. Seventy-five patients (53.6%) had four haemorrhoidal arteries ligated. A total of 82 patients (58.6%) had a 'fourth' haemorrhoidal artery in the left anterior one o'clock position. Symptoms of bleeding, prolapse, pain and itching resolved in 92, 65, 68 and 60% of patients who presented with the respective symptoms preoperatively. CONCLUSION: There is a fourth haemorrhoidal artery consistently found in the left anterior one o'clock position. Adequate treatment of this artery minimises the recurrence of haemorrhoidal symptoms.