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SERVICES - HAEMORRHOID SURGERY
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 Piles or haemorrhoids are the leading cause of perianal disease. These are swollen or dilated veins located from venous cushions at 3 positions 3-4 cm within the anal canal. When the ligaments attaching the haemorrhoids to the anal canal become loose due to chronic straining from constipation, age or previous childbirth, they prolapse through the anal canal causing bleeding, swelling, itching and pain.
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 The management of less severe cases is possible through dietary, medicinal and ligation techniques in the office setting. In haemorrhoid ligation, a special grasper or suction device is used to draw haemorrhoid tissue into a proctoscope. Thereafter rubber bands are placed on the base of the haemorrhoid. This is best for internal haemorrhoids and will cause the haemorrhoid to slough off and for the wound to heal with scarring thereby reducing vascularity and bleeding. Maximal effects are noted at 6 weeks.
Sometimes however when prolapse is irreducible or bleeding is significant, surgery is necessary.
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 Closed haemorrhoidectomy is a method of surgical excision of the external haemorrhoid component closure of the wound using absorbable sutures. In current practice, minimal skin is taken and the procedure can often be done as a day surgery procedure. This results in faster healing as opposed to the previous open technique. Formal haemorrhoid techniques like this result in better cosmesis as excess skin can be trimmed.
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 Stapled haemorrhoidectomy using the PPH stapler has allowed a safe, rapid and pain free experience for patients in the majority of situations. This device fires a double row of staples within the anal canal that disrupts the blood supply of the haemorrhoids and also hitches the prolapse back into the anal canal restoring the normal position. Because there is no external skin wound, recovery is rapid and relatively pain free. This procedure is now offered in a day surgery setting in selected patients.
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 Transanal Hemorrhoidal Dearterialization (THD)
This is a novel technique where the haemorrhoids are not removed but the supplying vessels are accurately identified by ultrasound and suture ligated using a special anal retractor under sedation. Recovery is fast and relatively painless.
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