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THD Doppler Method for hemorrhoids treatment with Dr Nemanja Zarić

Almost everyone once in a lifetime at least once had an issue with hemorrhoids. Discomfort while sitting, itching, even pain, are common, especially nowadays, because we are sitting for long during the day. We are less physically active and we do not eat properly. Let’s start with the anatomy, which says that hemorrhoids are a normal part of the anal canal.

Dr. Nemanja Zaric: “Hemorrhoids are swollen blood vessels which have an important functional role in the fine stool regulation. When it comes to hemorrhoids, then we are talking about a hemorrhoidal disease that must be treated, either conservatively with drugs or surgically. ” Dr. Nemanja Zaric is a specialist in general surgery and performs hemorrhoid surgeries at the Atlas Hospital using the THD method.

Dr Nemanja Zarić - hemorrhoid surgery
Dr Nemanja Zarić, general surgeon Photo: Alo.rs


What causes hemorrhoids?

Dr. Nemanja Zaric: “The main reason why hemorrhoids occur is the increased pressure in the final part of the colon-in the anal canal.

Who gets hemorrhoids most often?

  • This problem occurs in people who have chronic constipation, or who have chronic diarrhea.
  • It also appears in pregnant women, due to the increased pressure inside the abdomen during pregnancy and thus in the final part of the large intestine and in the anal canal.
  • It also happens to people who sit for a long time, for example the IT sector, developers, administrative workers and counter employees most often.

” So any reason that leads to hard stools, such as inadequate nutrition, failure to get enough fiber. Nutrition is very important in the treatment of hemorrhoids, which leads to increased pressure inside the anal canal that can lead to the occurance of the disease. It is estimated that 75% of adults will experience some of the symptoms of hemorrhoids at some point in their lives. ”

Hemorrhoids are divided into external and internal. Only the internal ones are treated surgically.

The main symptom that something is wrong with them is bleeding.

Dr. Nemanja Zaric: ” There are four grades of hemorrhoids, when we talk about internal hemorrhoids and those in an advanced stage, when there can be prolapse, or as they say, the bulge of hemorrhoids. If the hemorrhoids become prolapsed and get stuck, then they can hurt. So, what is important is that when you notice blood on toilet paper, which is the most common symptom, you should immediately consult a doctor because that blood does not have to be just from hemorrhoids, it could be from some more serious conditions and diseases, so it should not be neglected and postponed. ”

If you see bright red blood, then it is due to hemorrhoids, because it is venous blood. If you react to the appearance of the first symptoms and consult a doctor immediately, the therapy is simple and in most cases the problems can be solved without surgery.

THD - hemorrhoids

The difference between classical surgery and THD method

Dr. Nemanja Zaric: ” Depending on the grade, hemorrhoids can be treated conservatively or surgically. Conservatively, by local application of various creams and ointments that are applied, as well as by taking some medications that should make them shrink, so to speak. Let’s not forget, hemorrhoids are veins and nothing else.

When that does not give results or when the disease has already progressed, then we have several different options for surgical treatment. The classic operation for hemorrhoids involves hemorrhoidal artery ligation by cutting off the diseased hemorrhoid. It is a classic method that has been used for decades, maybe even longer. Now there are new methods of treating hemorrhoids that are used in the world, and in our country at the Atlas General Hospital. This is the THD method. The THD method does not cut the hemorrhoids, but does something called hemorrhoidal artery ligation. The THD treatment method is accepted as the standard treatment for hemorrhoids at Atlas General Hospital. ”

Why it is better and more comfortable for the patient to undergo treatment for hemorrhoids with the THD method

Dr. Nemanja Zaric: ” The essential difference is in what I mentioned a little while ago, there are no hemorrhoid cuts. Therefore, there are no vulnerable surfaces that in the post-operative course could be a source of problems or complications for the patient in terms of pain, above all, and long-term recovery. The THD method is used to tying “up” an artery, which delivers blood to a certain hemorrhoid. In case of the hemorrhoids of grade three or grade four even, then something called mucopexy is done- the hemorrhoid itself is sutured and returned to the place where it should be. ”

Recovery period after hemorrhoid surgery

The recovery period lasts 6-8 weeks, when the hemorrhoids should completely disappear. By ligating the hemorrhoid arteries, you have prevented the blood flow- so they have nothing to feed on and after 6-8 weeks they will withdraw. Most people have 6 hemorrhoidal arteries, or between 5 and 8. By default, it is assumed that all six hemorrhoidal arteries will be ligated during the operation, which will deprive the patient of pain in the long run.

Can hemorrhoids reoccur?

Dr. Nemanja Zaric: ” Hemorrhoids can reoccur because there are different anatomical variations. Maybe someone has eight such arteries. If such a situation occurs later in life, it does not require additional surgical intervention, but can be resolved conservatively. ”

Dr. Nemanja Zaric has been performing successfully the THD method at Atlas General Hospital.

Dr. Nemanja Zaric: ” I was trained in Rome, with Professor Ratto. He is an absolute authority on THD hemorrhoid surgery and has some 2,000 surgeries behind him. ”

What does THD mean?

Dr. Nemanja Zarić: “ THD stands for Transanal Haemorrhoidal Dearterialisation. It may sound complicated, but in fact it is not. Trans anal means that it is done through the anus, hemorrhoids are clear, dearterialization means that we ligate the artery. ”

The patient had internal hemorrhoids and came to see the doctor. We are interested in how it is determined whether you will operate it in the classic way or by the THD method.

Dr. Nemanja Zaric: ” In order to make a diagnosis, an examination is necessary. Anoscopy uses a small instrument – an anoscope. An anoscope is used to enter the anal canal so that we can see what the problem is. It often or relatively often happens that patients do not only have a problem with hemorrhoids. Patients have an associated problems that is usually an indication for a proctological surgery, such as anal fissure, anal fistula, or hypertrophied papillae. Then we have to slightly adjust the approach. When it comes only to hemorrhoids, then we have to decide based on the findings, whether it will be a classic operation or the THD method. THD can indeed be done in the vast majority of cases. “Sometimes it is necessary to treat the patient conservatively, prepare him, and improve a little that local finding, before the operation is performed. ”

thd doppler hemorrhoid surgery


THD method is already standard in Atlas General Hospital. A large number of patients had already had this type of surgery. They recovered quickly and forgot about the problems that had been very unpleasant.

Dr. Nemanja Zaric: ” Now we are operating a 36-year-old patient, who came because of hemorrhoid issues, due to bleeding, above all.” At the examination, we found that he had hemorrhoids of grade three, so we decided in agreement with the patient to do the THD procedure for him today.

The procedure will take about half an hour. The patient will be under general anesthesia and will be able to go home during the day. More precisely, in a few hours, when we see that everything went well, that there is no bleeding as some possible first post-operative complication, then we will let him go home. The patient will arrive at the first check-up in 14 days. The second control is in about a month and that is standard. Of course, if there are some possible complications that are always possible, we will see each other earlier, but normally the patient comes after 14 days for the first check-up. And it takes 6 to 8 weeks for the hemorrhoids to completely disappear. After eight weeks, we say that the problem is completely solved.

You can see the whole article by clicking on the link HERE.

Although this method is practiced in several institutions in Serbia, patients find out about it only when they come for an examination. When doctors confirm that the THD method can be used in a specific case, patients usually opt for it, because it provides them with a very quick solution for hemorrhoid issues, and after the intervention, they are completely cured.

The price of THD hemorrhoid surgery at Atlas General Hospital is 135,000 dinars and all costs are included in this price.

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Osmana Đikića 3, Belgrade

1100 Belgrade, Serbia

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