In cases where lesser methods have failed or where the piles are persistently prolapsing (external or 3rd degree), operative intervention may be required. The following are some of the procedures currently available.

Stapled haemorrhoidectomy

PPH – procedure for prolapsed haemorrhoids.

In this method, a specially designed instrument is used to remove a ring of tissue inside the back passage which contains the roots of the haemorrhoids. The instrument immediately closes the defect in the tissues with a ring of tiny surgical staples. As there are no open wounds in the skin, the procedure is not painful and generally well tolerated, with recovery mostly completed in a few days.

This operation is currently my preferred treatment option. It is suitable for all piles except those which are very large and prolapsing (3rd degree).

HALO (haemorrhoidal artery ligation)

In this procedure, the blood vessels supplying the haemorrhoids are identified using an ultrasound probe and then tied off with stitches causing the haemorrhoids to shrink. It is also well tolerated but long-term efficacy is unproven.

Open (traditional) Haemorrhoidectomy

The traditional operation is perhaps still the gold standard for the long-term relief of haemorrhoid symptoms. It is, however, a painful and unpleasant procedure to endure. The haemorrhoid masses are cut away, their feeding blood vessels secured with stitches. Open wounds remain on the skin which must heal together in the recovery phase, often up to 4 weeks. In some instances, healing can be accompanied by scarring, resulting in troublesome narrowing of the back passage.
This operation now tends to be reserved for the largest prolapsing (3rd degree) haemorrhoids.

Pre-operation appearance of large piles

Appearance immediately after open haemorrhoidectomy