Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed
CPT4 code
Name of the Procedure:
Hemorrhoidectomy, Internal, by Transanal Hemorrhoidal Dearterialization (THD), 2 or More Hemorrhoid Columns/Groups with Ultrasound Guidance and Mucopexy
Summary
In layman's terms, this advanced procedure removes or reduces internal hemorrhoids by cutting off their blood supply using ultrasound-guided techniques and lifting the prolapsed tissue. It's a targeted approach to manage multiple hemorrhoid clusters.
Purpose
The procedure addresses internal hemorrhoids that cause discomfort, bleeding, or prolapse. The goal is to reduce symptoms, improve bowel function, and enhance the patient's quality of life by eliminating problematic hemorrhoids.
Indications
This procedure is suitable for patients experiencing:
- Persistent bleeding hemorrhoids
- Prolapsed hemorrhoid tissue
- Significant pain or discomfort
- Ineffective response to other treatments Patient criteria include severe symptoms impacting daily activities and the failure of less invasive treatments.
Preparation
Prior to the procedure, patients should:
- Fast for a specified period, usually starting the night before surgery.
- Adjust or stop certain medications as directed by the healthcare provider.
- Undergo a colonoscopy or other diagnostic assessments to ensure the absence of other colorectal conditions.
Procedure Description
- The patient is placed under sedation or anesthesia.
- An ultrasound probe is used to locate the arterial blood supply to the hemorrhoids.
- Specialized tools are used to stitch the arteries, cutting off blood flow to the hemorrhoids.
- Prolapsed tissue is repositioned and secured (mucopexy).
- The procedure is minimally invasive and targets multiple hemorrhoid groups in one session.
Duration
The procedure typically takes about 30 to 60 minutes, depending on the number of hemorrhoid clusters treated.
Setting
The procedure is usually performed in a hospital outpatient clinic or a surgical center.
Personnel
The procedure involves:
- A colorectal or general surgeon
- An anesthesiologist or nurse anesthetist
- Nursing staff to assist with the procedure and patient preparation
Risks and Complications
Common risks include:
- Mild pain or discomfort
- Bleeding Rare complications may involve:
- Infection
- Urinary retention
- Recurrence of hemorrhoids Management includes medication, follow-up visits, and in some cases, additional treatments.
Benefits
Expected benefits include:
- Relief from pain and bleeding
- Improved bowel function
- Reduced risk of hemorrhoid recurrence Patients often notice an improvement within a few days, with full recovery in a few weeks.
Recovery
Post-procedure care involves:
- Managing pain with prescribed medications
- Keeping the surgical site clean and dry
- Adhering to a high-fiber diet to prevent constipation
- Avoiding heavy lifting and strenuous activities for a few weeks Follow-up appointments are necessary to monitor healing and progress.
Alternatives
Alternative treatments include:
- Rubber band ligation
- Sclerotherapy
- Infrared coagulation
- Stapled hemorrhoidopexy Each has its own pros and cons regarding effectiveness, recovery time, and potential risks compared to THD.
Patient Experience
Patients may feel mild discomfort or pressure during the procedure. Post-procedure, pain management is a priority, and patients often experience relief from symptoms relatively quickly. Comfort measures such as sitz baths and topical ointments can aid recovery and improve the overall experience.