Surgical treatment of Piles / Hemorrhoids:

1. Banding
2. Sclerotherapy
3. Coagulation Therapy
4. Hemorrhoidal artery ligation

1. Hemorrhoidectomy
2. Hemorrhoidopexy

Banding is an out-patient procedure used to treat Internal Hemorrhoids. This is also called ‘Rubber Band Ligation’ procedure where in a tight band is placed around the base of the hemorrhoid to cut off the blood supply. The band may not be painful but can cause a little discomfort. The patient has to see the doctor more than a couple of times for this procedure with a gap of 2 months between each visit. Your urologist will let you know the next date of your appointment.   Banding is not recommended for patients taking blood thinners because of high risk of bleeding complications.

Also called ‘Chemical procedure’, where in a chemical is injected into the hemorrhoid to shrink and stop bleeding. Typically this is a painless procedure with very little blood loss. If you are taking blood thinners, please mention this to the doctor. This method is recommended for people taking blood thinners. This procedure has better success rate for small internal hemorrhoids.

Coagulation therapy is also called infrared photocoagulation. In this treatment, the hemorrhoid is made to shrink using infrared light, heat or extreme cold. This too is a day care procedure and performed with a device called ‘anoscope’.

Anoscopy is a visualization procedure in which the scope is inserted into the rectum. The urologist will be able to see the internal hemorrhoids. The patient may experience a little tingling and discomfort during the treatment.

Hemorrhoidal Artery Ligation (HAL), also known as Transanal Hemorrhoidal Dearterialization (THD), is another procedure used to remove Hemorrhoids without anesthesia. This method employs ultra sound to locate blood vessels causing hemorrhoid and ligates/closes off those blood vessels. This is more effective way than banding. The cost of this procedure is higher than others and also the pain induced due to the procedure lasts for little longer time.  Typically, this is employed when the rubber band procedure fails.

This method is typically employed for treating large, external Hemorrhoids or to treat the ones that are internal but prolapsed.  First, the non surgical methods are tried and only when they fail (or depending on the doctor’s diagnosis), this method may be chosen.  The procedure is performed under general anesthesia or regional anesthesia or local anesthesia. You must talk to your urogynecologist before he/she decides which one to use.

In this method, surgeon cuts out the large hemorrhoids and once done, you will be under observation. This procedure requires in-patient admission to the hospital. Once your doctor sees that your condition is good, he/she may allow you to go home.  Post surgery, pain and infections may be expected.

Hemorrhoidopexy is sometimes referred to as stapling. Usually done as a day care procedure using local, general or regional anesthesia.  This method is employed to treat prolapsed hemorrhoids where in they are put back into the rectum and the blood supply to these blood vessels is cut off. As a result, the hemorrhoids shrink and will be reabsorbed by the body.  Recovery from stapling takes less time and is less painful compared to hemorrhoidectomy.