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THD (Transanal Haemorrhoidal Dearterisation)
Many modalities have been used in the treatment of first and second degree piles, including medications, rubber ligation and sclerotherapy. Surgical excision is performed if non-surgical options failed to address the problem. A newer technique of Transanal Haemorrhoidal Dearterisation (THD) has gained popularity in the treatment of early stages of piles over the past 5 years. This technique involved the ligation of the distal branches of the superior rectal artery and thus drastically reducing blood supply to the haemorrhoidal plexus. This in turn reduces the haemorrhoidal congestion with the result of decrease haemorrhoidal bleeding and prolapse. The use of a transanal vascular Doppler allows precise ligation of the haemorrhoidal vessels at or above the level of the anorectal junction. Unlike rubberband ligation of piles, this procedure does not produce the distressing sensation of tenesmus. It is relatively painless procedure as the ligation of vessel is proximal to the dentate line and transitional epithelium of the anal canal. A haemorrhoidopexy can also be performed if there is a small component of hemorrhoidal prolapse. Many studies have shown that THD is a very effective procedure for the treatment of first and second degree piles. THD is less effective for third degress piles, especially if the predominant symptom is prolapse and not bleeding. However, THD can still be offered to patient with third degree piles and refused excisional haemorrhoidectomy.
KH Ng et al. The Forth Branch of the Superior Rectal Artery and its Significance in Transanal Haemorrhoidal Dearterisation (THD). Techniques in Coloproctology 2010 Dec;14(4):345-8.
Severe cases of 3rd and 4th degree pile will require haemorrhoids surgery by your piles surgeon. Traditional piles surgery is notorious for the high level of pain because of the large open wound after surgery. However, newer technique of stapled haemorrhoidectomy has greatly reduced the pain after piles surgery. This surgical technique has become increasing popular over the past ten years. To date, many large international trials have shown that randomized controlled a clear advantage of stapled haemorrhoidectomy compared to conventional piles surgery. The complication rate of this new procedure is also comparable to that of conventional methods.
Benefits of Stapled Haemorrhoidectomy
Treatment for Piles-stapled (PPH)
KH Ng et al. Experience of 3711 stapled haemorrhoidectomy operations. British Journal of Surgery. 2006 Feb.
KH Ng et al. Modified Stapled Haemorrhoidectomy: A suggested improved technique. Australian New Zealand Journal of Surgery. May 2008.
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