Several minimally invasive surgical procedures have been recently developed to treat hemorrhoids
without any excision. About 25 years ago, a non-excisional procedure providing doppler-
guided ligation of the hemorrhoidal arteries has been proposed - named “hemorrhoidal dearterialization”.
The original technique has been modified over the years, and indications were expanded.
In particular, a plication of the redundant and prolapsing mucosa/submucosa of the rectum
(named “mucopexy”) has been introduced to treat hemorrhoidal prolapse, without excision of the
hemorrhoidal piles. At present, the THD® Doppler procedure is one of the most used techniques to
treat hemorrhoids. Aim of this technique is to realize a target dearterialization, using a Doppler
probe with the final purpose to reduce the arterial overflow to the hemorrhoidal piles. In the case of
associated hemorrhoidal prolapse, a mucopexy is performed together with Doppler-guided dearterialization.
The entity and circumferential extension of the hemorrhoidal prolapse guide the mucopexy,
which can be considered tailored to a single patient; the dearterialization should be considered
mandatory. Advantages of this surgical technique are the absence of serious and life-threatening
postoperative events, chronic complications, and limited recurrence risks. The impact of the
procedure on the anorectal physiology is negligible. However, careful postoperative management
is mandatory to avoid complications and to guarantee an improved long-term outcome. Therefore,
regular physiologic bowel movements, excessive strain at the defecation and strong physical activity