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Transanal Haemorrhoidal Dearterialisation (THD) is a minimally invasive surgical procedure used to treat haemorrhoids.

It may also be called Haemorrhoid Ligation, Haemorrhoidal Artery Ligation or Doppler guided Ligation.

If you have been diagnosed with Grade 2, 3 or 4 haemorrhoids and your GP or consultant has recommended surgery, you may be eligible for THD, a NICE approved procedure.

What happens during THD?

During the THD procedure, the blood-supplying arteries of the haemorrhoid are precisely located with a fine, specially designed proctoscope allowing maximum precision via a doppler ultrasound probe. Each of these arteries is then gently sutured through a small operating window of the same proctoscope, making this technique extremely gentle and safe. As the procedure is carried out in the area above the dentate line (an area without sensory nerves), you won't feel any stitches during or after the procedure.

In case of prolapsed haemorrhoidal cushions (3rd and 4th degree haemorrhoids), a running suture with a few stitches is applied to the prolapsed piles, being careful that all stitches remain above the dentate line. The aim is a firmer adhesion of the mucosa to the deep layers of the rectal wall.

The THD procedure differs from other surgical techniques in the following ways:

  • It uses the same fine instrument for locating the arteries, suturing them and applying, if necessary, subtle stitches to any prolapsed piles (the instrument always remains in the same position while working through the small window, making the procedure extremely gentle)
  • It does not cut or remove any haemorrhoidal tissue, hence post-operative complications are significantly reduced compared to haemorrhoidectomy
  • Since the blood-supplying arteries are not only tied off with rubber bands (which can slip and cause bleedings), but sutured, the THD procedure has been associated with far less post-operative complications and better long-term results
  • In most cases, patients resume their normal activities within 24 – 48 hours
  • After the procedure, some patients mayt feel a slight discomfort in the rectal area which usually disappears within a few days. If any prolapse has been sutured, some patients may feel a slight urge to defecate, which is related to the repaired prolapse and which is gradually disappearing as well.

Due to its low recurrence rates compared to traditional types of surgery, the THD procedure has been adopted in numerous hospitals throughout Europe.

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