The best surgery for your haemorrhoids depends on the type and severity of the problem.
Surgery is normally recommended for grade 3 and 4 haemorrhoids, for strangulated internal haemorrhoids, if you have other anorectal conditions that need surgery, and where other procedures haven’t worked.
Learn about grades of haemorrhoids.
This procedure is also called HAL-RAR which stands for haemorrhoidal artery ligation-recto anal repair. For internal haemorrhoids, stapling can be an effective solution. Stapling is a method of disrupting the blood supply to the haemorrhoid using a special surgical instrument. Stapling results in less postoperative pain and shorter recovery compared with conventional surgery, but there’s a higher rate of haemorrhoid recurrence. The frequency of complications is similar to that following standard haemorrhoidectomy.
Transanal haemorrhoidal dearterialisation (THD) is a newer type of hemorroidopexy that can be used for treating internal haemorrhoids. It involves the use of an ultrasound probe to locate the arteries inside your rectum that are feeding your haemorrhoids with blood. Once they’re located, your surgeon ties a suture around them to reduce the blood supply. If you have prolapsing haemorrhoids, your surgeon then runs a stitch from the top to the bottom of each haemorrhoid and tightens the thread. This lifts up the tissue that’s hanging down. After this, the haemorrhoid is sutured back in place. The haemorrhoids then gradually shrink over the next 4 to 6 weeks. Discomfort is minimal because there’s no cutting and that part of your rectum has no pain nerves anyway. Most people can go back to work after 1 or 2 days.
Closed haemorrhoidectomy consists of removing the haemorrhoid using an instrument, such as a scalpel, scissors, electrocautery or laser followed by wound closure using sutures. Postoperative care includes frequent sitz baths, painkillers, and avoiding constipation. See Aftercare. Closed haemorrhoidectomy is successful 95% of the time.
Although this technique has the most postoperative discomfort and pain, it does have the best long-term results with the lowest recurrence rates. New methods are being devised to decrease the pain associated with the surgery and should allow for a better experience.
In an open haemorrhoidectomy, haemorrhoid tissue is cut away in the same manner as in a closed procedure, but here the incision is left open. Your surgeon may opt for open haemorrhoidectomy when the location or amount of disease makes wound closure difficult, or there’s a high risk of postoperative infection. Often, a combination of open and closed technique is used.
Which surgery is best for me?
The best choice of surgery depends on the type and severity of your condition, your general health and your surgeon’s skills. Stapling and THD offer less discomfort and a shorter recovery time but with a greater chance of recurrence compared to the more invasive surgeries.
As haemorrhoids aren’t usually life threatening, you may want to go for a conservative approach first because you can have a second procedure if it’s not successful.
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