What are the surgical options for haemorrhoids?

Written by: Mr Andrew Clarke
Edited by: Laura Burgess

Haemorrhoids (piles) represent a ring of blood vessels that we all have within the anal canal. They naturally form soft cushions that help maintain our bowel control by creating a seal. Haemorrhoids become symptomatic if they enlarge and fall out (prolapse), if they bleed or if a blood clot forms within them and they become painful.

They can produce mucus and hinder continence leading to soiling of underwear. They can cause itching (pruritus ani). Pregnancy can often initiate the problem and those who strain excessively are predisposed. Obesity and sometimes a family history of piles may be implicated.


What kind of haemorrhoids require surgery and what are the options?

For those with ongoing symptoms and with haemorrhoid prolapse, surgery may be necessary. Rubber band ligation (RBL) is an attractive first-line therapy and is often performed at the time of endoscopy. Small rubber bands are applied through a narrow plastic tube (proctoscope) using a suction device. They are placed high up in the anal canal, where few sensory nerves are encountered and as such, there is very little discomfort associated with their application. Recovery is swift and patients are usually able to return to work the following day. The bands fall off leaving an area of scaring with shrinkage of the haemorrhoids.

If the haemorrhoids are bulky and patients have symptoms associated with prolapse or heavy frequent bleeding, the treatments described may not be sufficient. There are several operations described which bear testimony to how difficult the problem can be to address.

Modern treatments aim to deal with the piles from their site of origin within the anal canal. This is because on the outside the skin is rich in nerve endings and operations in this area tend to be much more painful. In addition, surgery designed to remove the skin of the haemorrhoid can lead to scarring and narrowing of the canal (stenosis) together with damage to the inner sphincter muscle.

What is the RAFAELO procedure?

The RAFAELO procedure is a novel treatment that utilises safe and reliable radio frequency technology that reduces or eliminates, the common symptoms of internal haemorrhoids. A special needle probe is inserted into the haemorrhoidal cushion. Radio frequency energy is applied, which shrinks the haemorrhoids by heating the tissue.

What are the benefits of the RAFAELO Procedure?

The RAFAELO procedure is minimally-invasive and takes no longer than 15-20 minutes to perform. It can be carried out using local anaesthetic (although some patients may choose to have a mild sedative or even a general anaesthetic). Most patients report very little pain or discomfort and as a result, the recovery time is very short.

What is the HALO (haemorrhoid artery ligation operation) procedure?

The HALO operation offers an attractive surgical option. Most usually it is performed under a general anaesthetic (although can be performed with the patient awake using local or regional anaesthesia) and in the majority as a day case. A proctoscope linked to a doppler machine is carefully rotated within the anal canal to identify feeding vessels to the piles high in the anal canal and an absorbable suture is used to tie it off. This produces shrinkage of the pile. If there is prolapse a second suture can be used to elevate or plicate the tissue, pulling it inward.

What are the risks of HALO?

HALO surgery carries very little risk. As it uses dissolvable sutures and does not necessitate removal of tissue, lasting damage to tissues is extremely rare. The most common problems occur early on in the post-operative stage and include pain and bleeding, both of which are self-limiting in the vast majority.

About 30% of patients will experience discomfort following surgery but in nearly every case this dissolves away after a few days without any intervention. Warm baths, use of local anaesthetic creams and stool softeners all help. Recurrence of the problem in a small percentage can occur but is usually nothing like as bad as the first presentation and the HALO procedure can be safely repeated if ever needed.

Overall patients report high satisfaction rates with the procedure. The operation has been performed for over 15 years and long-term complications from it are very rare.

What is recovery like?

Most procedures are performed as a day case and patients are usually discharged with laxatives. Patients will inevitably see blood in the days following surgery which settles quickly in the vast majority.


If you are suffering from piles, then do not hesitate to book an appointment with a specialist

By Mr Andrew Clarke

Mr Andrew Clarke is a leading consultant general, colorectal and laparoscopic surgeon based in Poole and Bournemouth in Dorset. After gaining his qualification from the University of Manchester in 1988, Mr Clarke went on to gain further training in numerous teaching hospitals in the north-west. In 2002 Mr Clarke became a Consultant Surgeon at Manchester Royal Infirmary and by 2004, he moved to Dorset where he set up a dedicated pelvic floor surgery service in Poole. 

Mr Clarke's surgical skills cover general and colorectal surgery and he has a special interest in using endoscopy and laparoscopy to treat hernias, haemorrhoids and to repair pelvic floor disorders. Mr Clarke's contribution to treating pelvic floor conditions, such as prolapse, constipation and bowel incontinence, has seen him become founder of the Southern Pelvic Floor society and member of the National Pelvic Floor Society in the UK.

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