THD is another option for hemorrhoid surgery: It has proven to be an effective treatment for hemorrhoids but because it is a relatively new operation the risk of recurrence is unknown.

THD is a Doppler Guided Hemorrhoid Artery Ligation procedure. The procedure is particularly useful in patients whose primary problem is prolapse and bleeding of their internal hemorrhoids (the hemorrhoids protrude and do not go back in easily). This procedure utilizes an ultrasonic Doppler probe inserted into the anal canal to locate the position of the main arteries feeding the enlarged hemorrhoid tissue. The arteries are then tied off with a suture and the excess hemorrhoid tissue is sutured up into its normal position within the anal canal, essentially cuting off the blood flow to the hemorrhoid and restores normal anatomy. It does not, however, remove the hemorrhoids. It is not particularly useful for patients with substantial external hemorrhoids or skin tags.

THD is also an outpatient operation and utilizes the same type of anesthetic as the standard hemorrhoidectomy. The advantage this operation offers is in the degree of pain experienced and the rapidity of recovery. Although it is by no means a painless operation, it is, in most cases, associated with significantly less pain than the standard hemorrhoidectomy. Many patients are able to return to normal activity within 2-3 days following surgery. 

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