CPT® Code 46948

Hemorrhoidectomy, internal, by transanal hemorrhoidal dearterialization, 2 or more hemorrhoid columns/groups, including ultrasound guidance, with mucopexy, when performed

Transanal hemorrhoidal dearterialization (THD) is a minimally invasive surgical procedure designed to treat symptomatic internal hemorrhoids classified as grade II to IV. Hemorrhoids are essentially natural vascular structures located in the anal canal that can become problematic when the veins within them become varicose, leading to an overflow of arterial blood and subsequent dilation of the hemorrhoidal plexus. The THD technique employs a method known as dearterialization, which involves the suture ligation of the arteries supplying blood to the hemorrhoids, utilizing Doppler ultrasound guidance for precision. This is achieved with the aid of a specialized anoscope and a Doppler transducer, which help identify the hemorrhoidal arteries that branch from the superior rectal artery, typically located 2 to 3 centimeters above the pectinate line. The pectinate line serves as an important anatomical landmark that differentiates between internal and external hemorrhoids based on their position relative to this line. Once the superior rectal arteries are accurately located, they are ligated to reduce blood flow to the hemorrhoidal plexus, thereby alleviating the symptoms associated with hemorrhoids. In cases where there is prolapse of the hemorrhoids, a procedure known as mucopexy may also be performed. This involves lifting the mucosal membrane and suturing it to reposition the hemorrhoidal cushions, ensuring that the final suture placement is at least 5 millimeters above the pectinate line. The THD technique is advantageous as it minimizes postoperative pain and preserves the anatomical integrity of the anal canal, significantly lowering the risk of complications such as incontinence or other functional impairments that can arise from traditional excisional hemorrhoid surgeries.