Reply to correspondence by Smart and Watson

Excerpt

We appreciate the interest shown by Smart and Watson [1] in our article published in Techniques in Coloproctology [2]. Their remarks open a complex debate on the “applicability” of a new specialist technique to the “average” colorectal surgeon. The authors of the letter are skeptical about the ability of the average colorectal specialist to perform an operation for hemorrhoidal disease [e.g., transanal hemorrhoidal dearterialization (THD)] with less than a 10% recurrence rate in the medium term. Our 9.5% recurrence rate at 44 ± 29 months mean follow-up should be considered as a realistic percentage of failure when applied to a patient population such as the one in our study. We have been transparent in our patient selection process and treatment algorithms in our study published in Techniques in Coloproctology [2] and more so than many centers that either perform only THD or that perform rubber band ligation (RBL) as a first intervention. Whatever the amount of specialization within “general” surgery toward coloproctology, similar results should be obtainable given adequate training and support. In our institution, we have tried to optimize and standardize the THD procedure as much as possible over a long period of time. We have been able to share our experience through presentations, hands-on courses and publications, including this one published in Techniques in Coloproctology. Sharing this past experience should be regarded as an attempt to help others to achieve the same results as our center rather than be criticized as “excessive self-citations.” We paid a lot of attention to the failure rate and reasons for failures and adapted our technique accordingly, for instance modifying the dearterialization, from proximal to distal, and optimizing the mucopexy technique, reducing recurrence rates. We would hope that Smart and Watson would want to share improvements in technique in a similar way for operations that they have a special interest in, and not deter the surgeon approaching an operation from performing the procedure correctly and achieving similarly good results. …