THD Hemorrhoid Surgery: Steps, Recovery and What to Expect

Hemorrhoids are swollen blood-filled cushions fed by small arteries. In THD the surgeon finds these arteries with a Doppler probe and ties them off with a stitch, so blood flow drops and the hemorrhoids shrink. If they prolapse, a lifting stitch (mucopexy) puts the tissue back in place. The stitches sit above the dentate line, an area with few pain nerves.

• Grade 2 or 3 internal hemorrhoids with repeated bleeding or prolapse.
• Home care or banding has not worked.
• Some grade 4 cases, depending on the surgeon's assessment.

External skin tags may need separate treatment, because THD targets internal hemorrhoids. To tell hemorrhoids from a fissure or fistula, see Hemorrhoids, fissure or fistula?.

1. Before: an examination, sometimes a colonoscopy depending on age and symptoms, and an enema to clear the area.
2. Anaesthesia: usually general or spinal, depending on the case.
3. During: a proctoscope with a Doppler probe locates the arteries, they are tied off, and any prolapsing tissue is lifted. There is no external wound.
4. After: most patients go home the same day or the next day, with painkillers and stool softeners.

Many patients feel fullness or a frequent urge to open their bowels for the first few days, which settles gradually. In a comparative trial reviewed by NICE, pain at one week was lower after artery ligation than after stapled surgery. Desk work usually resumes within days, and your doctor will advise on your own timeline. What matters most afterwards: fibre, water and no straining.

NICE found the procedure an effective alternative to hemorrhoidectomy or stapled surgery in the short and medium term, with no major safety concerns. Possible problems include minor bleeding or, rarely, bleeding that needs treatment, pain on opening the bowels and temporary difficulty passing urine. In studies with a year or more of follow-up, bleeding returned in about 1 in 10 patients.

Heavy bleeding or passing clots, fever, being unable to pass urine, or pain that gets worse instead of better.