Transanal Hemorrhoidal Dearterialization (THD)

Transanal Hemorrhoidal Dearterialization (THD) is the least invasive method for treating hemorrhoids. Unlike traditional procedures, this surgical technique does not involve the removal of tissue, as in a conventional hemorrhoidectomy.

THD uses an anoscope equipped with a Doppler ultrasound probe to locate the terminal branches of the superior hemorrhoidal artery, which are then sutured internally. Once the arteries are identified, the surgeon ligates the branches to cut off the blood supply to the hemorrhoids.

Because no hemorrhoidal tissue is removed, the anatomy of the anal canal remains intact, preserving the function of the sphincter responsible for continence. Additionally, the postoperative recovery is significantly less painful than with traditional surgery.

THD is often combined with hemorrhoidopexy, a procedure that repositions prolapsed hemorrhoidal tissue back to its original position. 

This helps relieve one of the most common symptoms in advanced stages of hemorrhoidal disease.

In summary, THD is a surgical technique that includes both arterial ligation and hemorrhoidopexy, offering several advantages over other methods for treating hemorrhoids — notably less postoperative pain and faster recovery.

Most patients are able to return to their normal activities within 48 hours after undergoing Transanal Hemorrhoidal Dearterialization (THD).

Transanal Hemorrhoidal Dearterialization (THD) is a surgical method recommended for patients with grade II and III hemorrhoids, and in certain cases, grade IV. These patients typically experience swelling, congestion, pain, and rectal bleeding caused by their hemorrhoids.

THD is usually performed alongside muco-hemorrhoidal pexy, so the degree of mucosal prolapse through the rectum is a key factor in determining whether this surgery is appropriate.

The classification of hemorrhoids by grade is as follows:

• Grade I: Hemorrhoids do not protrude outside the anus. The main symptom is bleeding during bowel movements. In these cases, not only is THD not indicated, but surgery is generally not required.
• Grade II: Hemorrhoids prolapse through the anus during bowel movements but return to their original position afterward.
• Grade III: Hemorrhoids protrude from the anus and must be manually repositioned.
• Grade IV: Hemorrhoids are permanently prolapsed and cannot be repositioned, often causing severe pain.

THD is designed to treat internal hemorrhoids, which are varicose veins located inside the rectum.

As with any surgical procedure, it is essential that a qualified physician determines the most appropriate treatment for each individual case.

That’s why Operarme offers a free surgical consultation with a specialist in Proctology to evaluate your condition and recommend the best approach.

Operarme offers you a free surgical consultation with a proctologist, the specialist in conditions affecting the anus and rectum.

Whether you’ve already decided to undergo treatment for hemorrhoids using the THD method (Transanal Hemorrhoidal Dearterialization) or you're still looking for the most suitable surgical option, you can request an immediate and free surgical assessment.

To schedule your consultation with a proctologist, you can do so directly through our website by clicking any of the “Request Appointment” buttons, filling out the web form, or by calling our patient service team at +34 91 141 33 56.

Our patient service team will be happy to guide you through the entire process and explain everything you need to know, including the benefits of choosing Transanal Hemorrhoidal Dearterialization with Operarme.

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The Patient Service Team will answer all your questions and, once you’ve requested your consultation, they will stay in continuous contact with you. 

If you decide to proceed with surgery, they will coordinate everything — including preoperative assessments, hospital admission, and payment information — to ensure a smooth and stress-free experience.

On the day of your appointment, please bring all the documentation requested by the Operarme Patient Service Team, including any medical tests, lab results, and previous medical reports that may assist the Coloproctology specialist in making a more accurate diagnosis.

During the consultation, the proctologist will conduct a medical interview to understand your lifestyle, current symptoms, and will review the medical records you provide. Based on this information, the specialist will determine whether you are a suitable candidate for Transanal Hemorrhoidal Dearterialization (THD).

If the doctor confirms that you are eligible for the THD procedure and both of you agree to move forward with the surgery, you may schedule the operation during the same visit. However, our Patient Service Team will contact you the following day to confirm your final decision about proceeding with the surgery.

If you decide to go ahead, the Operarme team will guide you through the next steps and coordinate any necessary preoperative appointments to ensure everything is ready for your procedure.

Once you’ve decided to undergo Transanal Hemorrhoidal Dearterialization (THD), the proctology specialist will explain the need for the preoperative stage to assess your current health and ensure the surgery is performed safely.

The preoperative process for THD includes the following tests:

• Blood tests to evaluate your general health and coagulation status.
• Electrocardiogram (ECG) to assess the health of your heart.
• Chest X-ray — This test will only be required if the anesthesiologist deems it necessary.

Once these tests are completed, you will have a consultation with the anesthesiologist who will assist during the surgery. In this consultation, the anesthesiologist will review the results of the tests and ask questions regarding your current medications and lifestyle habits to determine any potential risks related to anesthesia.

After the Coloproctology Team confirms your suitability for the THD procedure and the Anesthesia Team evaluates your condition, you will be ready to attend the hospital on the day of your surgery.

Rest assured that from the very beginning, a member of the Operarme Patient Service Team will be available to answer any questions and guide you throughout the entire surgical process.

Transanal Hemorrhoidal Dearterialization (THD), also known as the THD method, involves suturing the hemorrhoidal artery using a Doppler guide and performing a muco-hemorrhoidal prolapse pexy.

THD is an outpatient surgery, meaning patients can leave the hospital on the same day as the procedure.

Upon arrival at the hospital and after providing the necessary documentation, the medical and nursing team will guide you to the operating area, where you will be given appropriate clothing for the procedure.

Once you are ready and taken into the operating room, you will meet again with the surgeon you had the consultation with, along with the nursing team. It is very likely that, before entering the operating room or starting the surgery, an intravenous line will be placed to administer any medications required during the procedure.

Additionally, the proctology specialist will instruct you to use an enema to empty the distal colon the night before the surgery, and you will need to fast for at least 6 hours prior to the procedure.

The Transanal Hemorrhoidal Dearterialization (THD) procedure follows these steps:

• You will be positioned in the proctological position, meaning your legs will be elevated on a surgical chair.
• After positioning and administration of a sedative, the anesthesiologist will inject local anesthesia into the intersphincteric space, numbing the entire anal circumference.
• The coloproctology specialist will then use a lateral view Doppler anoscope to locate the arterial branches that need to be sutured.
• Once the branches of the superior hemorrhoidal artery are identified, the surgeon will ligate them with a suture around the artery.
• Next, a lifting procedure is performed, where the prolapsed hemorrhoidal mucosa is sutured back into its original position.

This procedure helps to reduce congestion and stop the bleeding from the hemorrhoidal masses, minimizing any prolapse and restoring the hemorrhoidal tissues to their correct position.

The entire Transanal Hemorrhoidal Dearterialization procedure takes approximately 20 to 35 minutes.

After your Transanal Hemorrhoidal Dearterialization (THD) surgery, the medical and nursing team will transfer you to the recovery room, where you will begin your recovery process. 

Since THD is a minimally invasive procedure, you won’t need to stay overnight at the hospital. In fact, in most cases, you can leave just a few hours after the surgery.

Although it is rare, it may be necessary to stay overnight in the hospital until the surgical team determines it is safe for you to be discharged.

After undergoing Transanal Hemorrhoidal Dearterialization (THD), you will be able to return to work quickly.

While it is normal to experience some mild discomfort after the procedure, it will gradually decrease over time. You can manage these discomforts with common pain relievers until they completely subside.

Do you need dearterialization hemorrhoids surgery?

Request a free and immediate appointment with our General Surgery specialist

Make appointment