2. THD America THD Procedure for Hemorrhoids A Kinder Gentler Approach David Zeiler, M.D.

3. Who Has Hemorrhoids? Actually, you do! EVERYONE does!

4. Normal Anatomy Normal Hemorrhoid

5. An Ancient problem Hippocrates (460-377 BC) Wrote: On Hemorrhoids (400 BC) - A treatise on the nature and treatment of hemorrhoids, a pain in the rectum

6. Causes low-fiber diets straining with defecation Prolonged sitting on a toilet (eg, while reading) Pregnancy Age Genetics

7. Hemorrhoid Symptoms Bleeding: bright red blood in the toilet or on toilet tissue Pain Discomfort: itching and or burning Swelling Prolapse (protruding hemorrhoid tissue)

8. Enlarged Internal Hemorrhoid

9. Enlarged Internal Hemorrhoid with Prolapse

10. What Causes Hemorrhoid Disease? Patients with symptomatic Hemorrhoids appear to have excess blood flow into their Hemorrhoids.

11. What Causes Hemorrhoid Disease? Vessels Connective tissue Over time, this excess blood flow causes tissues to swell and stretch.

12. Eventually, swelling and stretching may lead to varying degrees of symptoms.

13. You Are Not Alone! Hemorrhoids affect up to 86% of Americans and has no age barrier. Hemorrhoids are a condition that will happen to 50% of Americans by the age of 50. Hemorrhoids can occur at any age but are more common as people get older. Among younger people, they are most common in women who are pregnant or have had a child.

14. Hemorrhoid Treatments Diet / Drugs Injection sclerotherapy Cryotherapy Photocoagulation Rubber Band Ligation Surgery

15. Rubber Band Ligation

16. Hemorrhoid Treatments Why might I consider a surgical treatment for my Hemorrhoids?

17. Surgical Treatments More Invasive Traditional surgery Stapled hemorroidopexy (PPH) Transanal hemorrhoidal dearterialization (THD) Hemorrhoidal tissue excision Rectal mucosal tissue excision No excision Less Invasive

18. Surgical Treatments

19. What is THD? “Transanal Hemorrhoidal Dearterialization” THD treats the sourceof Hemorrhoid disease, not the symptoms THD uses sound waves to locate the hemorrhoidal arteries Once each artery is located the surgeon ties off the blood flow If necessary your surgeon will repair the prolapse which restores and “lifts” the tissue back to a more natural position No tissue is cut or excised THD is performed as an out-patient surgery Most patients get back to normal activities within 4 days

20. Tying off of Hemorrhoidal Artery

21. Lifting of Hemorrhoidal Prolapse (Pexy)

22. Completion of Hemorrhoidal Lift (Pexy)

23. THDProcedure Benefits Summary Minimally-invasive No excision of tissue, low/minimal complication rates Operation in low/no pain zone of anal canal Surgeon can hear and see that arteries are tied off Venous outflow remains to dissipate blood supply Restoration of prolapsed tissue (Lifting) Minimized post-op pain and discomfort Patients back to normal activities within 4 days

24. David Zeiler, M.D. Triangle Surgical Associates 115 Crescent Commons Drive Suite 200 Cary, NC 27518 (919) 851-5055 Patient Education Please ask me for a THD patient education brochure

25. The End uranus

26. Thank You! David Zeiler, M.D. Triangle Surgical Associates 115 Crescent Commons Drive Suite 200 Cary, NC 27518 (919) 851-5055 Mon - Fri 9:00am - 5:00pm THD: Treating the Source – Not the Symptoms