Transanal haemorrhoidal dearterialisation (THD/HALO)

The transanal haemorrhoidal artery devascularisation (THD) procedure is an operation which has revolutionised the surgical treatment of haemorrhoids (also referred to as piles).

The procedure utilises a mini-Doppler ultrasound probe to identify and treat the blood vessels which supply the haemorrhoids, thereby causing them to shrink. No cutting or excision of tissue is involved during the procedure. Therefore the THD procedure causes less pain and tissue damage. Your recovery will be faster compared to conventional surgical treatment of haemorrhoids.

The operation is performed through the anus (transanal). The procedure is designed to reduce the blood supply to the haemorrhoids (devascularisation) by using an ultrasound to guide the surgeon to place a suture or stitch across the haemorrhoidal arteries. This makes the haemorrhoids shrink. The haemorrhoidal arteries are the blood vessels that supply the haemorrhoids.  

The operation usually involves a general anaesthetic and takes about 40 minutes to perform. A small, disposable, plastic proctoscope (which has an embedded micro-Doppler ultrasound device) is placed in the anus.

This embedded ultrasound device is then used to locate the precise position of the blood vessels that supply the haemorrhoids (haemorrhoidal arteries). These blood vessels lie within the rectal wall above the actual haemorrhoids. This allows the surgeon to place a very precise stitch into the haemorrhoidal arteries in order to tie them off. This causes the haemorrhoids/piles to shrink.

If a patient undergoing the procedure also has problems with protrusion or prolapse of haemorrhoids, the surgeon can also place additional stitches to lift or pull the loose haemorrhoidal tissue up into the back passage. The additional “lift” of the haemorrhoids is sometimes called a haemorrhoidopexy.

The term HALO means haemorrhoidal artery ligation operation. THD procedure and HALO are the same operation.

The reason for two different names for the same operation is because two companies make their own version of the disposable proctoscope which the surgeon uses to perform the procedure. 

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