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Transanal Haemorrhoidal Dearterialisation

Overview

This procedure is a surgical treatment for haemorrhoids. It is an alternative to rubber band ligation and to full surgical haemorrhoid removal – haemorrhoidectomy.

Often abbreviated to 'THD', the procedure has been widely adopted around the world after having been developed originally in Italy.

The main benefits of this procedure compared to a haemorrhoidectomy are:

  • No incision wounds or scarring – no post-surgical wound management required.
  • No post-surgical discharge.
  • Less pain.

How should I prepare for surgery?

The day before admission we will contact you to confirm admission time and to give you instructions regarding any fasting requirements for the procedure. You should bring any x-rays in with you (and ensure you take them with you when you are discharged). Also bring any current medication in with you to the hospital.

For day procedures you should not drive yourself home when you are discharged – please ensure you have made other transport arrangements.

If you smoke, you should reduce smoking before your procedure. Our strong recommendation is that you give up entirely at least 6 weeks before the procedure, or at least one week beforehand. Smoking greatly increases the possibility of chest infection and hampers natural wound healing.

In the case of major surgery, please inform Dr White's team if you take:

  • Warfarin.
  • Aspirin.
  • Plavix.
  • Anti-inflammatory medication.

We will need to discuss these medications with you prior to your surgery.

Dr White will provide you with a full set of pre-operative instructions for your specific surgery well ahead of the day of surgery.

What is involved in the procedure?

A transanal haemorrhoidal dearterialisation takes 40 minutes or so to complete. It is conducted under general anaesthesia.

The objective of surgery is to treat the main symptoms of haemorrhoids, namely bleeding and prolapse, by reducing blood flow through the arteries that supply the haemorrhoids. This is achieved by locating the appropriate arteries using an ultrasound probe and then suturing these arteries.

At this point any prolapsed haemorrhoids can be corrected using a technique called 'mucopexy', where the haemorrhoids are fixed using sutures.

Recovery Guidelines

Hospital Stay

No overnight hospital stay is required – only a period of observation (generally around three hours) immediately after the procedure has been completed, before the patient is able to return home. Patients should ensure that they do not drive themselves home and should rest for the remaining part of the day as the effects of the anaesthetic will still be present.

Pain Management

There is often moderate to severe pain after this procedure. There may be some pain once the effects of the local anaesthetic have worn off around two hours after the procedure.

If this is the case we recommend the following combination of Panadol and Ibuprofen for the initial 48-hour period after surgery:

  • Two (500mg) Paracetamol tablets every four to six (4-6) hours.
  • Two (200mg) Ibuprofen tablets every six to eight (6-8) hours.

If pain continues beyond this period, or if it becomes severe, you should contact your doctor.

In rare cases, this pain relief may not be sufficient – in which case you will need to take stronger pain relief. You will require a prescription for Panadeine Forte – two (500mg) tablets every six to eight (6-8) hours.

Bleeding

Minor levels of bleeding are normal for up to two weeks after surgery.

Bowel Movements

During the first 2-3 days you may feel the need to have a bowel motion more than usual. After this period things should revert to normal.

Longer Term / Recovery Period

This varies from patient to patient, but most patients are able to resume work and other normal activities within a week or two of the procedure.

Surgical Risks

All types of surgery are subject to the following risks, which are rare, but can occur:

  • Allergic reaction to medication / anaesthetic.
  • Bleeding.
  • Difficulty breathing.
  • Infection.

Complications of this procedure are very rare and 90% of patients will experience full relief of all symptoms. Where the haemorrhoids are large – known as 'fourth degree' – there is a greater likelihood they will recur.

Risks that can occur include:

  • Bleeding (more than that indicated above).
  • Inability to urinate immediately after surgery (in which case a catheter may need to be inserted).
  • Continued and / or severe pain beyond the first 2-3 days.

When to contact Dr White

Most surgical procedures are uneventful, with minimal complications. However, you need to be aware of the following symptoms as they may indicate a developing serious complication...

  • Fever.
  • Excess bleeding.
  • Difficulty urinating.
  • Severe or increasing pain.

If you experience any of these symptoms or have any concerns after your surgery, please contact the rooms on 07 5598 0955 for advice.

A post operative appointment will be made for you before you are discharged from hospital. If you are discharged on a weekend, after normal surgery hours or it is not clear what follow up appointments are required, then contact the rooms the next working day to make an appointment.