When conservative treatments like high-fibre diets, lifestyle adjustments, and topical creams fail to provide relief, a haemorrhoidectomy becomes the definitive solution for Grade III and IV piles. The primary goal of this surgery is to physically remove or reposition prolapsed tissue, effectively restoring normal bowel function and eliminating chronic discomfort.
In Singapore, patients typically choose between two primary surgical paths: the conventional haemorrhoidectomy and the modern stapled haemorrhoidectomy. However, because these are fundamentally different procedures, it's important to understand the logic behind each method, so that you can decide which approach aligns best with the severity of your condition and your recovery goals.
Understanding a Conventional Haemorrhoidectomy
The conventional haemorrhoidectomy remains as one of the global gold standard for the surgical treatment of severe piles. Unlike less invasive methods that reposition tissue, this is an excisional procedure, meaning the problematic haemorrhoidal tissue is physically removed.
The Cut and Stitch Procedure
Commonly performed using the Milligan-Morgan (open) or Ferguson (closed) techniques, the surgeon makes precise incisions around the external or internal haemorrhoid clusters. Once the swollen vascular tissue is excised, the surrounding area is either left to heal naturally or closed with absorbable sutures. This method ensures that the source of the prolapse or bleeding is eliminated from the anal canal.
Who Are the Best Candidates?
This approach is particularly effective for patients dealing with:
- Large External Piles: Since these sit outside the reach of internal stapling devices, physical excision is often the only way to achieve permanent relief.
- Complex or Mixed Cases: Patients suffering from both internal and external piles simultaneously.
- Grade IV Piles: When the tissue is permanently prolapsed and cannot be pushed back inside.
The reason surgeons continue to recommend the conventional method is its unmatched track record. It offers the lowest rate of recurrence among all surgical options. While the recovery period is typically longer due to the nature of the incisions, the long-term success rate makes it a highly reliable choice for those seeking a permanent solution to chronic piles.
Understanding Stapled Haemorrhoidectomy
The stapled haemorrhoidectomy, also known as the Procedure for Prolapse and Haemorrhoids (PPH), is a modern surgical alternative designed to treat internal piles without the need for external incisions. Unlike conventional surgery that removes the tissue entirely, this method focuses on repositioning the prolapsed tissue.
The Procedure for Prolapse and Haemorrhoids
During this procedure, a specialised circular stapling device is used to remove a ring of excess tissue just above the haemorrhoid clusters. This action serves two purposes: it lifts the prolapsed tissue back into its natural anatomical position and simultaneously cuts off the blood supply to the piles, causing them to shrink and eventually wither away.
Who Are the Best Candidates?
This technique is highly effective for specific patient groups and conditions, including:
- Internal Prolapsing Piles: Specifically, Grade III internal piles that can still be reduced manually.
- Working Professionals: Individuals who prioritise a fast recovery and need to return to their daily routines and work schedules as quickly as possible.
- Multiple Internal Clusters: Patients with several internal haemorrhoids that would otherwise require multiple incisions if treated conventionally.
The reason patients opt for this method is the reduced post-operative discomfort. The stapling occurs above the dentate line, which is a boundary in the anal canal that separates the sensitive lower area from the less sensitive upper region. Because there are far fewer pain-sensing nerves in this upper zone, patients typically experience significantly less pain compared to surgeries involving external cuts.
Side-by-Side Comparison: Key Decision Factors
Choosing between these two methods requires balancing immediate comfort against long-term outcomes. Here are the primary factors to consider when discussing your options with a specialist:
- Pain Levels and Post-Operative Comfort: Conventional surgery typically involves more immediate post-operative pain due to incisions in the sensitive external anal area. In contrast, the stapled method is performed in a less sensitive zone, significantly reducing discomfort during the initial healing phase.
- Recovery Timeline: Patients undergoing conventional surgery usually require a downtime of two to four weeks for the surgical sites to heal completely. Those opting for a stapled procedure often experience a much faster recovery, with many returning to their regular routines within one to two weeks.
- Recurrence and Long-Term Success: While stapling offers a faster return to daily life, conventional haemorrhoidectomy remains the gold standard for preventing piles from returning. Because the tissue is entirely removed in the conventional approach, the risk of long-term recurrence is generally lower.
- Suitability for External Piles: A stapled haemorrhoidectomy is generally ineffective for treating purely external piles because the stapling device only reaches internal tissues. If your primary concern involves external clusters, a conventional excision is usually necessary to ensure the problematic tissue is fully addressed.
Choose the Right Procedure with Colorectal Practice (Piles)
Choosing the right haemorrhoidectomy procedure for you ultimately depends on the grade of your condition, the presence of external piles, and your personal recovery priorities. While the stapled method offers a faster return to daily life with less immediate discomfort, the conventional approach remains the gold standard for those seeking the lowest possible risk of recurrence.
At Colorectal Practice (Piles), our surgeons —including medical director Dr Dennis Koh—are dedicated to providing comprehensive care for all colorectal conditions. Our clinic prioritises patient comfort and long-term health, ensuring that every individual receives a treatment plan backed by years of surgical expertise.
If you're struggling with chronic piles, don't wait for the condition to worsen. Book an appointment with us today for a specialist assessment.