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Piles Treatment by Transanal Hemorrhoidal Dearterialization

Piles, or haemorrhoids, are actually blood-vessel-containing tissue pads that lie in the anal canal. These tissue pads, also known as anal cushions, enlarge over time and start to droop down lower in the canal till they eventually protrude from the anus. As they are filled with blood vessels, the commonest symptom is bleeding during bowel movements. As the cushions are filled with enlarging blood vessels, the principle underlying treatment is cutting off the flow of blood into the anal cushions. Once the blood flow has been cut off, the blood vessels and hence the anal cushions start to shrink and eventually retract.

Traditional treatment for large piles has been surgical removal of the piles tissue. Post-operative pain is generally severe, as the skin around the anus is very sensitive. Many patients are on medical leave for 2-4 weeks because of the pain.

About 10 years ago, a method that uses a stapler device to remove a cuff of piles tissue was introduced. This procedure, known as Stapled Haemorrhoidectomy, removes piles and simultaneously applies a ring of staples high up the anal canal which is less sensitive. Because of this, it results in less pain compared to the traditional surgery. However there is still some pain, and the downtime is generally about a week to 10 days.

More recently a new technique using an ultrasound probe to guide suture-ligation of the blood vessels feeding the piles has gained popularity. Once the feeding vessels are sewn shut, the piles shrink over time. No excision is necessary and hence is much less invasive and much less painful than the other procedures. Most patients feel a discomfort over a period of 2-3 days. The downtime is much shorter than other procedures, and complication rates are low. It is however less effective for patients with very large (4th degree) piles. For the very large piles, stapled haemorrhoidectomy is still recommended.

The above diagram shows that piles originate in the anus and as they enlarge over time,
start to appear externally.

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