Transanal haemorrhoid dearterialisation (THD) at Cambridge Hospital

What is transanal haemorrhoid dearterialisation (THD)?

THD is a NICE-approved procedure to reduce the size of haemorrhoids by suturing their blood-supplying arteries.

It's also sometimes called haemorrhoid ligation, haemorrhoidal artery ligation, or doppler guided ligation.

Is THD right for me?

If you've been diagnosed with Grade 2, 3 or 4 haemorrhoids and your GP or consultant has recommended surgery, you may be eligible for THD.

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.

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 subtle stitches to any prolapsed piles, so the instrument always remains in the same position while working through the small window, making the procedure extremely gentle and safe
• It does not cut or remove any haemorrhoidal tissue, hence post-operative complications are significantly reduced compared to haemorrhoidectomy
• Since the blood-supplying arteries aren't tied off with rubber bands (as with haemorrhoid banding), but sutured, the THD procedure has been associated with far less post-operative complications and better long-term results
• Due to its low-recurrence rates compared to traditional types of surgery, the THD procedure has been adopted in numerous hospitals throughout Europe.
  

Recovery from THD

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. 

However, some patients may feel a slight discomfort in the rectal area afterwards, which usually disappears within a few days. If any prolapse has been sutured, some patients may feel a slight urge to defecate. This is related to the repaired prolapse and will gradually disappear as well. 

In most cases, patients resume their normal activities within 24–48 hours.