Piles And Haemorrhoids

Many modalities have been used for first- and second-degree piles treatment, 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 degree piles, especially if the predominant symptom is prolapsed and not bleeding. However, THD can still be offered to patients with third degree piles and refused excisional haemorrhoidectomy.