Types of Haemorrhoid Surgery: Which One Is Right for You?

When Is Surgery Recommended?

Surgery for haemorrhoids is generally considered when conservative treatments, such as dietary changes, topical medications or minimally invasive procedures, fail to provide adequate relief. It may also be recommended for:

• Severe or Persistent Symptoms: Chronic pain, itching, or swelling that interferes with sitting, working, or even sleeping can make surgery worth considering.
• Grade III or IV Haemorrhoids: Internal haemorrhoids that prolapse (protrude outside the anus) and either need to be manually pushed back in or cannot be pushed back in at all.
• Repeated Bleeding: Frequent bleeding that leads to fatigue or anaemia may require surgical intervention.
• Thrombosed External Haemorrhoids: Thrombosed external haemorrhoids can be extremely painful and may not resolve without surgical removal.
• Strangulated Haemorrhoids: Known as a strangulated haemorrhoid, this condition causes severe pain and needs urgent attention.

Types of Haemorrhoid Surgery

Different surgical methods are available, each designed to address specific types and severities of piles. Some commonly performed types of haemorrhoid surgery in Singapore include:

• Haemorrhoidectomy

  A haemorrhoidectomy involves surgically removing the swollen tissue under general or regional anaesthesia. The surgeon makes small incisions around the affected area to remove the piles, and the wound may be closed with fine sutures. This procedure is often recommended for severe or large haemorrhoids, including Grade III and IV internal piles, large external piles, or thrombosed cases. It offers long-term relief and has a low risk of recurrence when performed correctly.

  Recovery may take a few weeks, and temporary pain or discomfort is common as the area heals. You may also experience mild bleeding or difficulty passing stool at first, but these usually improve as recovery progresses.

• Stapled Haemorrhoidopexy

  Stapled haemorrhoidopexy, sometimes called a stapled haemorrhoidectomy, works by repositioning prolapsed haemorrhoidal tissue instead of removing it completely. Using a circular stapling device, the surgeon removes a ring of excess tissue above the piles, cutting off their blood supply and pulling them back into place.

  Because it involves less tissue removal, this technique usually results in less pain and a quicker recovery than traditional haemorrhoidectomy. It’s often suitable for Grade II and III internal haemorrhoids, though it carries a slightly higher risk of recurrence and rare complications such as bleeding or chronic discomfort.

• Rubber Band Ligation (RBL)

  If your piles are still in the early stages, Rubber Band Ligation (RBL) may be a simple yet effective option. In this quick, minimally invasive procedure, a small rubber band is placed around the base of an internal haemorrhoid to cut off its blood supply. Within a few days, the haemorrhoid shrinks and falls off naturally.

  RBL is typically performed in the clinic without anaesthesia and is suitable for Grade I and II haemorrhoids, and sometimes early Grade III cases. However, it’s not recommended for external piles or advanced prolapsed haemorrhoids.

• Transanal Haemorrhoidal Dearterialization (THD)

  Transanal haemorrhoidal dearterialisation (THD) is a minimally invasive method that uses a Doppler ultrasound to locate and tie off the arteries supplying blood to the haemorrhoids. By reducing blood flow, the haemorrhoids gradually shrink while preserving surrounding tissue.

  This technique is suitable for Grade II and III internal haemorrhoids, and in some cases, moderate Grade IV piles that bleed or prolapse. Since there’s no cutting or tissue removal, patients often experience less pain and a quicker return to normal activities. THD, however, does not treat external piles, and there remains a small chance of recurrence or minor bleeding after surgery.

• Laser Haemorrhoidoplasty

  A newer, modern option, Laser Haemorrhoidoplasty uses a precise laser beam to shrink haemorrhoidal tissue from the inside. A fine laser fibre is inserted into the haemorrhoid, where controlled heat coagulates and seals off the affected veins, all without cuts or stitches. This technique is best for mild to moderate internal haemorrhoids but may not be ideal for very large or severely prolapsed ones, which may still require conventional surgery.

Factors to Consider When Choosing a Surgery

Every patient’s condition and lifestyle are different, so the best approach depends on more than just the grade of your haemorrhoids. Here are a few key factors your doctor will consider:

• Type and Severity of Haemorrhoids: The size, location, and degree of prolapse determine whether a minimally invasive procedure will be sufficient or if a full haemorrhoidectomy is needed.
• Patient’s Overall Health and Age: Younger and healthier individuals may tolerate more extensive procedures, while older patients or those with medical conditions may benefit from gentler options.
• Medical History and Patient Preference: If you prefer to avoid general anaesthesia or longer downtime, less invasive techniques like THD or RBL may be more suitable.
• Cost and Accessibility: Some procedures, such as laser surgery, may cost more or be less widely available. It’s important to discuss both effectiveness and affordability with your doctor.

If you’ve tried multiple remedies from creams to sitz baths but still find haemorrhoids affecting your daily comfort, it may be time to explore surgical options. Surgery, while daunting to think about, can often provide lasting relief and an improvement in quality of life.

At Colorectal Practice, our specialists provide comprehensive care for haemorrhoid management, from early-stage treatments to advanced surgical techniques. We’ll walk you through every step and support you in choosing the approach that best fits your condition and lifestyle. Call 6262 1226 to schedule your consultation today.