THD Surgery: Procedure, recovery, treatment and cost in Bangladesh

What is THD surgery?

THD stands for transanal hemorrhoidal dearterialization. It is also known as Doppler-guided hemorrhoidal artery ligation, or HAL.

During the procedure, the surgeon uses a specially designed proctoscope fitted with a Doppler probe. The probe helps locate the small arteries supplying blood to the haemorrhoids. Each identified artery is then closed with an absorbable stitch.

When the piles have dropped or prolapsed, the surgeon may perform a mucopexy at the same time. This involves lifting the loose tissue and securing it higher inside the anal canal.

No haemorrhoidal tissue is routinely removed. According to current colorectal surgery guidance, Doppler-guided artery ligation may cause less postoperative pain than excisional haemorrhoidectomy. However, there may be a greater possibility of the piles returning later.

Who may need THD treatment?

THD treatment is mainly considered for symptomatic internal haemorrhoids. It may be suitable for:

• Grade II piles with repeated bleeding or prolapse
• Grade III piles that come out and need to be pushed back
• Selected grade IV internal piles without severe external disease
• Piles that continue after medicine or office treatment
• Patients suitable for a procedure without routine tissue removal

Note: THD is not suitable for every type of piles. Large external haemorrhoids, blood clots, severe skin tags, infection or advanced combined internal and external piles may require another surgical method.

THD surgery procedure step by step

THD surgery follows a careful, minimally invasive process. The surgeon first locates the blood vessels supplying the piles, closes them with stitches and lifts any prolapsed tissue back into position. The main steps are explained below. 

Clinical examination and diagnosis

The colorectal surgeon first asks about bleeding, pain, prolapse, constipation and previous treatments. The examination may include a digital rectal examination, proctoscopy or anoscopy.

A colonoscopy may be recommended when the bleeding pattern, age, bowel habit or family history suggests another bowel condition.

Preparation before the operation

The medical team reviews the patient’s current medicines, allergies and health conditions. Blood tests, an ECG or other investigations may be needed depending on age and general health.

Patients taking aspirin, warfarin or another blood-thinning medicine must follow the surgeon’s instructions. These medicines should never be stopped without medical advice.

Fasting instructions depend on the planned anaesthesia. Some patients may also need an enema or limited bowel preparation before surgery.

Anaesthesia

THD surgery is usually carried out under general or spinal anaesthesia. The decision depends on the patient’s health, hospital protocol and the anaesthetist’s assessment.

Locating and closing the arteries

The surgeon inserts the Doppler-equipped instrument through the anus. The probe identifies the arteries supplying the haemorrhoids.

After locating an artery, the surgeon closes it with an absorbable stitch. Several arteries may be treated during one operation.

Mucopexy for prolapsed piles

When haemorrhoidal tissue hangs outside the anus, a running stitch may be used to lift it back into position. This combined procedure is often called THD mucopexy or THD-M.

THD surgery commonly takes around 20 to 40 minutes. The exact time depends on the number of arteries treated and the amount of prolapse. Many patients can return home on the same day or after a short hospital stay. Studies reviewed by the ASCRS reported operating times between approximately 19 and 35 minutes.

Recovery process after THD surgery

Mild pain, pressure, urgency or a feeling of fullness may occur during the first few days. Light bleeding can also happen, especially after passing stool. These symptoms should gradually improve. Many patients can walk on the day of surgery. Desk-based work may be possible within several days to one or two weeks. A physical job may require a longer break. Heavy lifting, hard exercise and prolonged straining should be avoided until the surgeon confirms that it is safe.

During recovery, patients may be advised to:

• Take prescribed pain medicine
• Use a stool softener when recommended
• Drink enough water
• Eat fibre-rich foods
• Avoid sitting on the toilet for too long
• Keep the anal area clean
• Attend scheduled follow-up visits

Benefits of THD surgery

THD offers several possible benefits for properly selected patients. It does not routinely remove haemorrhoidal tissue. Therefore, there are usually fewer open wounds around the anus. Many patients experience less pain and can return to normal activities earlier than after conventional excisional surgery. 

The procedure also preserves the normal haemorrhoidal cushions. These tissues have a natural role in helping the anal canal close properly.

Possible risks and limitations

THD surgery is generally safe, but no procedure is completely risk-free. Some patients may experience bleeding, temporary discomfort, urinary problems or recurring piles after treatment. 

• Bleeding
• Temporary urinary retention
• Urgency to pass stool
• Constipation
• Infection
• Continued prolapse
• Recurrent piles

THD surgery cost in Bangladesh

There is no fixed national price for THD surgery in Bangladesh. The final cost depends on several points, including:

• Grade and condition of the piles
• Whether mucopexy is required
• Hospital or surgical centre
• Doppler equipment charges
• Surgeon and anaesthetist fees
• Diagnostic tests
• Medicines
• Room category
• Follow-up care

For comparison, laser piles treatment at around BDT 45,000 to BDT 70,000. Stapled haemorrhoid surgery is listed at approximately BDT 50,000 to BDT 100,000 in private hospitals and specialised surgical centres.

Note: A THD quotation may fall within or above the broader cost of advanced piles surgery. However, this is only a general comparison, not a confirmed THD package price. Patients should request an individual written estimate after a clinical examination.

Before booking the procedure, ask whether the quotation includes the surgeon, anaesthetist, operating theatre, Doppler device, tests, medicines, hospital stay and follow-up appointments.

Consult an experienced colorectal surgeon for THD surgery

Persistent rectal bleeding, discomfort or prolapsed piles should not be managed through guesswork. The correct treatment depends on whether the patient has internal piles, external piles or another anal or colorectal condition.

Prof. Dr. Tariq Akhtar Khan is a colorectal and laparoscopic surgeon in Dhaka with more than 16 years of experience in piles and colorectal treatment. He assesses the type and grade of haemorrhoids before recommending THD, laser treatment, stapled surgery, conventional surgery or a non-surgical option.

Book an Appointment: 01985-860690

FAQs about THD surgery in Bangladesh

THD surgery often raises questions about pain, recovery, cost and long-term results. The answers below explain the most common concerns clearly and simply.