Transanal Haemorrhoidal Dearterialisation ('THD') is a surgical technique used to treat haemorrhoids in situations where other approaches, such as rubber band ligation, are unlikely to fully treat the condition and where the patient would prefer not to undergo full surgical removal of the haemorrhoids.
The THD technique was developed in Italy and has been widely adopted in the UK and Europe, and continues to be more broadly adopted in the US and Australia.
The aim of the procedure is to reduce the main symptoms of haemorrhoids - prolapse and bleeding - by reducing the blood flow through the arteries to the haemorrhoids. First, the arteries are located using a specially developed ultrasound probe and then they are sutured to reduce the distension of these blood vessels, thus reducing the blood flow.
Around six sutures are needed to achieve this. At the same time the surgeon may also complete a 'mucopexy', which is where any existing prolapsing haemorrhoids are fixed back in place using sutures.
The procedure, which is carried out under a general anaesthetic, takes around 40 mins. Afterwards patients are kept under observation for around three hours and generally then discharged at that point.
The main advantages of this procedure over the more conventional haemorrhoidectomy procedure are:
- No open wounds (so no requirement for special pads or frequent baths).
- No discharge after the procedure.
- Lower levels of pain.
Although the procedure involves less postoperative pain than alternative approaches, there will most likely be significant pain in the 2-3 days following surgery. To assist with this, after the procedure you will receive Oxycodone (a type of morphine taken orally) in case you experience any severe pain, although in most cases Panadol or Nurofen will suffice.
It is normal to feel the need to have a bowel motion more frequently than normal in the first 2-3 days after surgery. After that bowel activity and sensation should return to normal.
It is common for there to be some minor bleeding after surgery, which can last for up to 14 days.
Resuming day-to-day activity
This does depend on the individual patient, however many people are able to return to work within 5-7 days of the procedure, and others may require a 14 day recuperation period before returning to work.
The procedure is safe and complications are very uncommon.
For nine out of ten patients, a THD procedure will fully relieve haemorrhoid symptoms. Larger haemorrhoids (referred to as 'fourth degree haemorrhoids', the largest type) are more likely to recur than smaller ones. One in ten patients may need more treatment.
Around one in one hundred patients may need to be readmitted to control bleeding, and, in rare cases, patients may need to have a catheter inserted to help them pass urine shortly after the procedure.
Pain normally subsides within a few days of the procedure, although there are rare cases where it continues for longer.