Introduction
There are three surgical approaches for the treatment of haemorrhoids – rubber band ligation, haemorrhoidectomy and haemorrhoidal artery ligation with rectoanal repair (HAL-RAR). Read more about these procedures below.
Preoperative Instructions
The following guidelines should be followed prior to the haemorrhoidectomy and HAL-RAR procedures (no specific preparation is required for rubber band ligation)…
- Continue any regular exercise up until the day of the procedure.
- Eat a healthy and balanced diet.
- If you smoke, stop smoking at least four weeks before the procedure.
- Existing medication/s – some medications can impact surgery, particularly blood thinning medication and medicines for diabetics; you will be advised if any of your medications need to be ceased well ahead of the procedure, otherwise any other medication can be taken on the morning of the procedure with a small sip of water.
- In the 24-hour period prior to surgery: no solid food (or drinks containing cow's milk) should be consumed within 6 hours of surgery. Clear fluids (e.g. water, cordial) may be consumed until 2 hours before surgery and then nil by mouth from that point. If you are having a colonoscopy with your procedure, follow the guide on Bowel Preparation Instructions for Colonoscopy for your fasting times.
- You will be given an enema on arrival at hospital. Oral bowel preparation is not required for this procedure unless you are having a colonoscopy at the same time.
Procedures
Rubber band ligation (RBL)
Technically this treatment is not surgical as there are no cuts made. RBL is used to treat internal haemorrhoids and is generally recommended where other non-surgical treatments have not worked e.g. topical haemorrhoid creams. Rubber band ligation is only appropriate for small to moderate sized internal haemorrhoids (Grades 1, 2 and small Grade 3). It involves applying a special type of surgical rubber band above the haemorrhoid, which then falls off after 2-5 days, leaving a scar. This scar helps the haemorrhoid re-attach to the bowel wall, reducing the prolapse and bleeding. Contrary to what people think, RBL does not involve cutting the blood supply to the haemorrhoid off and does not cause the haemorrhoid to “fall off”.
The procedure involves using an anoscope or proctoscope (short tubular viewing devices) to view the haemorrhoids and a small clamp to fix them while they are ligated using the rubber bands. Rubber band ligation is usually performed in conjunction with another procedure such as a colonoscopy or flexible sigmoidoscopy, and therefore is performed under a light anaesthetic in hospital.
After the procedure it is normal for there to be some pain and there may be a sensation of needing to have a bowel motion. The normal pattern of bowel emptying may change for 1-2 weeks, with more frequent smaller bowel motions. Normal activity can generally be resumed within 24-48 hours of the procedure. Heavy lifting should be avoided for 7 days. Around 8-10% of people undergoing the procedure will require one or more further rubber band ligation procedures.
Haemorrhoidectomy
This procedure is conducted under a general anaesthetic as day surgery or short stay (overnight stay). During this procedure the troublesome internal haemorrhoids are cut away from the underlying internal sphincter muscle. Haemorrhoidectomy is generally recommended for large Grade 3 or 4 haemorrhoids.
Haemorrhoidal Artery Ligation and Rectoanal Repair (HAL-RAR)
This technique is suitable for the treatment of Grade 2, 3 and 4 haemorrhoids and is conducted under general anaesthetic as a day surgery procedure. It is an alternative treatment to a haemorrhoidectomy. It works by reducing blood flow to the haemorrhoids by tying off the arteries supplying blood to them. A doppler ultrasound probe is used to detect which arteries are supplying blood to the haemorrhoids (there are generally 6-9 arteries involved) and each artery is individually tied off. This is the “HAL” component of the procedure. If there are prolapsed haemorrhoids these are then repositioned using sutures, the “RAR” component of the procedure. Generally, the HAL procedure is painless as the suture is placed in the lower part of the rectum, which has no sensation. If a RAR is performed in addition, patients may experience discomfort for up to 5 days, however this is significantly less than a conventional haemorrhoidectomy.
Postoperative instructions
Please refer to the page Going Home after Haemorrhoid Treatment for instructions specific to your haemorrhoid operation.
Risks
- Bleeding.
- Urinary retention.
- Recurrence.
- Infection.
- Incontinence.
- Anal stenosis.
