Haemorrhoids / Piles

Haemorrhoids piles surgery treatments

What are Haemorrhoids /Piles?

By Dr. Tan Wah Siew
Haemorrhoids or piles are abnormally enlarged anal cushions

Haemorrhoids or piles are abnormally enlarged anal cushions, that are part of the normal anatomy in everyone but become problematic when the blood vessels within become engorged and bleed or prolapse with defaecation. Causes of piles include chronic constipation, excessive straining and pregnancy.

Treatment of haemorrhoids is dependent on its grade:

Grade 1:
Blood vessels are prominent but haemorrhoids do not protrude

Grade 2:
Protruding haemorrhoids that spontaneously reduce

Grade 3:
Protruding haemorrhoids that need to be reduced manually

Grade 4:
Protruding haemorrhoids that can no longer be reduced manually

Grade 1 and 2 haemorrhoids can usually be treated by increasing intake of fibre and water, thereby improving constipation and decreasing the need to strain when defaecating. Grade 2 haemorrhoids that do not improve with these measures can be treated with rubber band ligation. Grade 3 and 4 haemorrhoids may require surgery.

Type of surgeries:

Conventional Haemorrhoidectomy

The piles are removed with an electrocautery knife, and wounds generally take about 4 to 6 weeks to heal completely. The wounds tend to be fairly painful as the lower anal canal and anal skin are very rich in nerve endings. As such, strong painkillers and stool softeners are usually prescribed post-operatively.

Stapled Haemorrhoidectomy

A purpose built circular stapling device is used to remove a circumferential ring of haemorrhoid tissue. This method works by removal of a ring of haemorrhoids, disruption of the blood supply to the haemorrhoids as well as pulling up of the prolapsed haemorrhoids up to their usual position.

Transanal Haemorrhoidal Dearterialisation

An ultrasonic doppler probe is used to locate the arteries supplying the haemorrhoids and a stitch is then used to suture the artery, cutting off the blood supply of the haemorrhoids which then leads to shrinkage.

Ligsasure/Harmonic Haemorrhoidectomy

Removal of haemorrhoids is performed with a vascular sealing device (Ligasure) or ultrasonic device (Harmonic). Some studies have found that these methods result in significantly less immediate postoperative pain after haemorrhoidectomy.

Colon Cancer Surgeon - Dr Tan Wah Siew
Dr Tan Wah Siew

Senior Consultant Colorectal Surgeon

MBBS, MMed (Surgery), FAMS, FRCSEd

Dr Tan Wah Siew was senior consultant surgeon at the Department of Colorectal Surgery, Singapore General Hospital (SGH) prior to her move to private practice. She was the first female consultant colorectal surgeon in the history of SGH, and was one of the earliest female surgeons in Singapore to be trained in robotic colorectal surgery.

She graduated from the Faculty of Medicine, National University of Singapore in 2003 and completed her Advanced Surgical Training in General and Colorectal Surgery at SGH in 2011. In 2013, she completed a one year Ministry of Health sponsored Healthcare Manpower Development Plan Fellowship (HMDP) at St. James University Hospital in Leeds, United Kingdom. While there, she trained in minimally invasive and robotic colorectal surgery for colorectal cancer, surgery for inflammatory bowel disease as well as treatment of locally advanced rectal cancers and recurrent pelvic cancers requiring removal of multiple organs and/or pelvic exenterations.

Singapore Colon Surgeon