Hemorrhoids / Piles Surgery - Indications, Types, Advantages & Cost

PACE Hospitals is one of the best hospital for piles surgery in Hyderabad. The hospital also has a state-of-the-art OT, 3D HD Laparoscopic and laser system, latest technology that ensures the surgery is performed safely and effectively.


Department of Proctology has a team of experienced piles surgery doctors – surgical gastroenterologist, proctologist to perform wide range of piles surgery, including: 

  • Hemorrhoidectomy: a traditional surgery for piles / hemorrhoids.
  • Stapled hemorrhoidopexy: a minimally invasive surgery for piles / hemorrhoids 
  • Laser hemorrhoidectomy: newer and less invasive laser surgery for piles / hemorrhoids.
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What is Piles surgery?

Hemorrhoids or Piles Surgery / operation is a procedure to remove hemorrhoids (swollen blood vessels in the anus and rectum). They can be caused by several factors, including constipation, straining during bowel movements, pregnancy, and obesity.


There are several types of piles surgery, each with its own advantages and disadvantages. The most common types of piles surgery are Open hemorrhoidectomy, Closed hemorrhoidectomy, Rubber band ligation, Stapled hemorrhoidopexy, Laser hemorrhoidectomy.


The success rate of piles surgery is high. Most people experience relief from their symptoms after surgery. However, there are some risks associated with the procedure, such as infection, bleeding, and pain.

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Hemorrhoid grades

Hemorrhoids are swollen blood vessels in the anus and rectum. They are graded on a scale of 1 to 4, with 1 being the mildest and 4 being the most severe.

  • Grade 1 hemorrhoids - These hemorrhoids are internal and do not prolapse outside of the anus. They may cause bleeding, but they are not painful.
  • Grade 2 hemorrhoids - These hemorrhoids prolapse outside the anus during bowel movements, but they spontaneously reduce (go back inside the anus). They may cause bleeding and discomfort.
  • Grade 3 hemorrhoids - These hemorrhoids prolapse outside the anus during bowel movements and require manual reduction. They may cause bleeding, discomfort, and itching.
  • Grade 4 hemorrhoids - These hemorrhoids are constantly prolapsed outside the anus and cannot be reduced manually. They may cause severe bleeding, discomfort, and itching.


The grading of hemorrhoids is important because it helps the gastroenterologist to select the best treatment option. Grade-1 to Grade-2 hemorrhoids can often be treated with conservative measures, such as over-the-counter pain relievers, stool softeners, and sitz baths. Grade-3 to Grade-4 hemorrhoids are severe conditions require surgery.

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Hemorrhoids / Piles surgery types

In the initial stages of piles/hemorrhoids, the patient is suggested for conservative management. In the patients with grade- 3 and grade- 4 piles/hemorrhoids, gastroenterologist often recommend surgery. The various piles operation procedures are categorised into:

  1. Non-surgical procedures - Rubber band ligation, Injection scleropathy, Infrared photocoagulation, Electrocoagulation, Lord's procedure
  2. Surgical procedures - Haemorrhoidal laser procedure (HeLP), Laser haemorrhoidoplasty (LHP), Hemorrhoidectomy, Stapled haemorrhoidopexy, Haemorrhoidal artery ligation (HALO)

1. Non-surgical procedures for Piles / Hemorrhoids 

Rubber Band Ligation for Piles / Hemorrhoids

Rubber band ligation/banding is the most used and cost-effective procedure for internal hemorrhoids. This procedure is done by an endoscope with forward and backward flexion using a suction elastic band ligator. Patients with grade 1 haemorrhoids, grade 2 haemorrhoids, and grade 3 haemorrhoids usually need this procedure.


Indications of rubber band ligation

  • To treat low grade hemorrhoids (grade-1 and grade-2) and in specific grade-3

Contraindications of rubber band ligation

  • Anorectal Crohn’s disease (chronic inflammatory bowel disease)
  • Patients who are not interested in follow-ups
  • The concurrent or synchronous anorectal infectious process
  • Immunodeficiency
  • Patients on anticoagulation therapy
  • Technical inability to pull sufficient tissue into the band ligator

Preparation for rubber band ligation procedure:


Before this procedure, the patient needs to talk with their gastro surgeon regarding the medications they consume, including over-the-counter drugs and supplements, so the gastro surgeon might advise them to continue or stop those medications. 

  • The patient needs to plan for someone to accompany them so that there would be support after the procedure. 
  • The patient will be advised to be on fasting for several hours prior to the surgery.
  • During the rubber band ligation procedure:
  • During this outpatient procedure, an elastic or rubber band is wrapped around the haemorrhoid's base. When the rubber band is placed, the blood supply to the piles is cut off, causing them to die and fall off on their own.
  • In most cases, rubber band ligation is painless and local anaesthetic will be given to the patient to reduce post-operative pain. It has the highest success rate (8 out of 10 cases will be cured). 
  • Due to rare serious complications, hemorrhoids could be treated with rubber band ligation in a highly safe and effective manner.

After the rubber band ligation procedure:

  • It is a simple outpatient procedure, so the patient may be advised to go home on the same day; after the procedure, the piles dry and fall off in a few weeks.
  • Patients may experience bleeding after the procedure; if this problem doesn't resolve in a few days, the patient might revisit the gastro surgeon.
  • There may be side effects, such as flatulence, swelling, and constipation after the procedure, so that the gastro surgeon might suggest some laxatives. 

Complications of rubber band ligation

Few people experience complications like:

  • Bleeding
  • Infection (pelvic sepsis)
  • Ulcers (anal fissures)
  • Fistula (it is an abnormal tunnel between the anal canal and skin)
  • Difficulty in urination or urinary retention (needs urinary catheterisation) 

Sclerotherapy Treatment for Piles / Hemorrhoids

Injection sclerotherapy is a popularly used technique for internal hemorrhoids and is the best technique compared to conventional surgery procedures due to fewer effects. It is of two types: endoscopic injection sclerotherapy (EIS) and cap-assisted endoscopic sclerotherapy (CAES). EIS is one of the best and most cost-effective treatments for internal haemorrhoids, whereas CAES is the best technique and has emerged in recent years.


Injection sclerotherapy is an outpatient procedure for treating grade-1 and grade-2 internal hemorrhoids. This procedure has minimal expenses, a low frequency of postoperative problems, and few significant consequences. It doesn't require hospitalisation.


Indications of sclerotherapy are:

  • Symptomatic haemorrhoids with bleeding
  • Patients with a risk of secondary bleeding
  • Patients with AIDS (acquired immunodeficiency syndrome)

Injection scleropathy contraindicated in:

  • Patients with thrombosed haemorrhoids (hemorrhoids with a blood clot)
  • Patients with cardiac, hepatic, renal and haematological diseases
  • Patients with asthma, allergic predisposition, or thrombophilia (blood-forming clots)
  • Patients with inflammatory bowel disease

Preparation for injection sclerotherapy procedure:

The patient is prepared to pass stools before the procedure, followed by lubrication of the anal canal and application of local anaesthetic gel. This procedure doesn't require general anaesthesia; the patient is placed in the left lateral position and projecting the buttocks. 

 

During the injection sclerotherapy procedure:

  • This procedure involves injecting sclerosants into the piles, resulting in shrinkage.
  • After the rectal examination, a predefined amount of sclerosant is injected, and the series of injections are repeated for the hemorrhoidal masses.

The sclerosants used for this procedure are aluminium potassium sulphate and tannic acid (ALTA), phenol in almond oil (PAO), quinine etc.


In some instances of haemorrhagic internal grade-1 and 2 haemorrhoids, ambulatory treatment with sclerosants such as quinine, phenol is administered; this causes scarring and a reduction in the size of blood vessels in hemorrhoidal tissues. An endoscopic examination is done before the sclerosant treatment. This course of therapy dramatically reduces rectal bleeding and rarely causes local or general problems, such as scarring. Only one or two sets of injections are recommended.


After the injection sclerotherapy procedure:

  • It is an outpatient procedure. EIS procedure takes nearly 1-2 weeks to treat haemorrhoids. During this time, the gastro surgeon might suggest developing good living habits, consuming a high-fibre diet and water to avoid diarrhoea and constipation.
  • The gastro surgeons might advise stool softeners post-procedures and avoid long sitting to prevent piles' recurrence. 

 

Complications of injection sclerotherapy

  • Septic infections (serious infectious condition)
  • Rectal necrosis (death of cells in rectal tissue)
  • Strangulated hemorrhoids (loss of blood supply to the hemorrhoids and gets pushed outside)
  • Recto vaginal fistula (fistula formation in between rectum and vagina)
  • Acute liver disorder
  • Pulmonary allergy 

Infrared Photocoagulation for Piles / Hemorrhoids

Infrared photocoagulation is a method that utilises infrared equipment made up of a light generator and a lengthy probe to use infrared light to thrombose and scar the haemorrhoid. This approach can be beneficial for treating small haemorrhoid tissues. This device emits infrared rays on the interior haemorrhoid by using heat. Scar tissue forms because of the heat produced by the infrared light and cuts off the blood supply to piles, leading to shrinkage.


Compared to traditional surgery, infrared photocoagulation is the safer technique because of its less invasive nature, less postoperative pain, secondary bleeding, absence of severe complications and quick recovery. There are no recurring costs other than the initial cost of the instrument. No extra training is needed to use this application, and this procedure is simple compared to the various traditional haemorrhoid treatment techniques used in medical practice.


Indications of infrared photocoagulation:

  • To treat earlier small haemorrhoidal tissues that are of low grades.

Contraindications of infrared photocoagulation:

  • There are no specific contraindications for this technique, which is well tolerated in the second trimester of pregnancy.

Preparation for infrared coagulation procedure:

The gastrosurgeon suggests the enema before the surgery to clean the rectum area, and it doesn't require any special dietary restrictions.

Anaesthesia is not suggested for this procedure; however, 5% xylocaine gel is applied in the anorectal region 10 minutes prior to the procedure.


During the infrared coagulation procedure:

The patient is placed in a left lateral position, and anoscopy visualises haemorrhoids before the procedure.

  • Then coagulation is done with the coagulator to a depth of 2mm. 
  • Finally, a white round spot appeared at the site, which is an indication of successful completion. 
  • After the infrared coagulation procedure:
  • The patient is advised to go home and resume the activities after the surgery. The patient is suggested to apply the anaesthetic gel before and after defecation to ease the burning sensation.
  • The patient is advised not to strain during defecation and might experience bleeding in the initial days.
  • The patient experiences the sensation of warmth and minor bleeding after the procedure.
  • Patients are instructed regarding the discharge measures while going home.
  • Recovery time for infrared coagulation procedure:
  • The patient may return to normal activities within a few days, followed by the procedure. 

Complications of infrared photocoagulation:

  • Bleeding in some cases of large haemorrhoids
  • Mild to moderate pain in some cases
  • Anal pruritis (itchy anus often called pruritis ani)  

Electrocoagulation for Piles / Hemorrhoids

Electrocoagulation is the method that uses electric current on internal hemorrhoids forming the scar tissue, resulting in stoppage of blood supply to the piles causing shrinkage. It is a bipolar electrocoagulation system that electro-coagulates the hemorrhoids using endoscopy, and later it was developed using many devices by researchers. 

This procedure mainly depends on the application of new devices.


Various procedures used in electrocoagulation are:

  • Electrocautery: It is of two types bipolar and monopolar electrosurgeries. The electro waves are produced in this procedure, resulting in corresponding tissue effects. This procedure uses two electrodes: an active electrode and a return electrode. In bipolar electrosurgery, active and return electrodes are placed at the surgery site. In contrast, in unipolar, the active electrode is placed at the surgical site and the return electrode somewhere else in the patient's body. 
  • Diathermy: Diathermy generates heat on tissues by passing an electrical current. Usually, the heat is caused due to the resistance developed in tissues. It is similar to electrocautery in coagulating piles. 
  • Heater probe coagulation: In this procedure, the heater probe has a thermocouple at the probe's tip and gets tissue coagulation by heating. 

Indications of electrocoagulation

  • Used to treat grade-1 and grade-2 internal hemorrhoids by bipolar electrocoagulation using diathermy and, in some cases, grade-3 and grade-4 piles.

Contraindications of electrocoagulation

  • Studies have shown that it is better to contraindicate in patients with defibrillators and cardiac pacemakers. Although it is not a specific contraindication, many debates are going on.

Preparation for electrocoagulation procedure:

This procedure doesn’t require any anaesthesia or enema preparation.


During the electrocoagulation procedure:

  • The gastro surgeon uses the tool and sends an electric current into hemorrhoid, leading to the cessation of blood supply to the hemorrhoid, resulting in hemorrhoid shrinkage.  It is a 10-to-30-minute outpatient procedure.

After the electrocoagulation procedure:

  • The gastro surgeon instructs the patient regarding post-operative measures and diet.
  • Recovery time for the electrocoagulation procedure:
  • Patients might be cleared of the condition after a single treatment and may resume normal activities on the same day.

Complications of electrocoagulation:

  • There is an incidence of developing diverticulosis (bulging pouches in the digestive tract), polyps (abnormal tissue growth on the mucous membrane), and solitary ulcers in patients undergoing endoscopic electrocoagulation. 

Lord's procedure for Piles / Haemorrhoids

Lord’s procedure is a manual procedure involving dilating the anal sphincter using the dilator. It decreases the anal pressure and makes the stools pass effortlessly.


It is a very economical procedure with fewer hospital stays and negligible postoperative complications.

 

Preparation for lord’s procedure:

A barium enema will be given, and a sigmoidoscopy might be undertaken prior to the procedure. This procedure was repeated under general anaesthesia. 


During the lord’s procedure:

This procedure includes dilating the anal canal and inserting a large foam plastic pack to prevent pile formation.


After the lord’s procedure:

Post-procedure pain is seen until the foam pack is removed; the gastro surgeon might suggest anaesthetics to reduce the post-operative pain .


Complications of lord’s procedure:

  • Incontinence. 

2. Surgical procedures for Piles / Hemorrhoids 

Laser surgery for Piles / Hemorrhoids

Haemorrhoidal laser procedure (HeLP) and laser haemorrhoidoplasty (LHP)


The hemorrhoidal laser procedure (HeLP) is necessary for patients with painful haemorrhoids when conservative measures have failed, and mucosal prolapse is uncommon or not symptomatic. This procedure involves the usage of laser beams shot (laser energy) from a diode laser platform to cut off the terminal branches of the superior rectal artery around 2-3 cm above the dentate line.


This procedure additionally involves suturing (HAL-RAR) when a prolapse needs to be treated, i.e., the vascular component is treated with laser, and the prolapse component is treated by suturing (MUCOPEXY). The laser treatment with suturing is known as HeLPexx (hemorrhoidal laser procedure +mucopexy).


Indications of laser surgery for piles:

  • To treat haemorrhoids of grade- 3 and grade- 4
  • To treat prolapsed haemorrhoids

Contraindications of laser operation for piles:

  • Patients with severe cardiac problems in the last 12 months and with chronic illnesses are advised against outpatient procedures. 
  • If the patient is using anti-coagulants, they should talk with the surgeon and keep it on hold as suggested by the gastrosurgeon because they may cause bleeding complications.

Preparations before a laser piles operation:

Patients well tolerate the laser beam. Due to this, general anaesthesia is typically unnecessary, might be suggested with local anaesthesia and doesn't need further preparations such as an enema.


During the laser procedure:

  • A laser hemorrhoidoplasty kit is utilised in this procedure so that the laser fibre can coagulate hemorrhoidal nodes.
  • Swollen haemorrhoids shrink because of the laser energy’s-controlled emission. This approach has been shown to avoid prolapse. 
  • In this procedure, hemorrhoidal tissue is accessed through a tiny perianal port.

After the laser procedure:

  • This kind of laser surgery for piles does not require clamps or other external items. Hemorrhoidoplasty doesn't require incisions or stitches. Hence it offers excellent recovery outcomes.

Complications of laser surgery for piles:

  • Postoperative bleeding (less)
  • Anal thrombosis (formation of a clot at the edge of the anus)
  • Urinary retention (difficulty in emptying the bladder)
  • Local swelling 
  • Finally, non-excisional laser treatments, such as LH and HeLP, are secure and efficient procedures. They ought to be considered for treatment unresponsive to conventional care.

Surgical haemorrhoidectomy for Piles / Hemorrhoids

In the circumstances like a failure of medical management, bulging out of the large component, advanced disease, coagulopathic patients with bleeding, and incarcerated internal haemorrhoids, surgical hemorrhoidectomy (traditional surgery) is advised. It is an inpatient procedure which is invasive and done under general anaesthesia.


Nearly 10% of the affected population needs surgical intervention to get rid of piles, and this procedure is mainly used to treat large third- and fourth-degree hemorrhoids. 


The surgical procedure will be done in open or closed hemorrhoidectomy based on the patient's condition. In a closed hemorrhoidectomy, excision is done on hemorrhoidal bundles using a sharp scalpel or scissor. It is commonly used in internal hemorrhoids. Open hemorrhoidectomy is also the same as closed hemorrhoidectomy, but the incision is left open; it is opted for by surgeons when the location or wound closure is difficult, or there is a likelihood of postoperative infection. Enema and anaesthesia are administered before the surgery. 


Indications of surgical hemorrhoidectomy:

  • Failure of non-surgical procedures.
  • To treat patients with large third- and fourth-degree hemorrhoids.
  • Bulging and mixed hemorrhoids.
  • Incarcerated (abnormal retention) internal hemorrhoids and patients with bleeding.

Contraindications of surgical hemorrhoidectomy:

  • Bleeding disorders.
  • Rectocele (weakened tissue wall between the vagina and the rectum).
  • Faecal incontinence (unable to control the bowel).
  • Portal hypertension patients with rectal varices (dilation of collateral submucosal vessels).
  • Patients with inflammatory bowel diseases / digestive disorders (Ulcerative colitis or Crohn's disease). 
  • Patients who can't tolerate or are unable to respond to anaesthesia.

Complications of surgical hemorrhoidectomy:

Early complications involved are

  • Urinary retention
  • Thrombosed hemorrhoids
  • Bleeding 
  • Late complications involved are 
  • Recurrent haemorrhoids (re-occurrence)
  • Skin tags (extra skin growth outside the anus)
  • Delayed haemorrhage 
  • Anal stenosis (narrowing of the anal canal)
  • Faecal incontinence

Stapler surgery for Piles / Hemorrhoids

Stapled hemorrhoidopexy, or stapler surgery for piles, is a novel procedure for treating internal hemorrhoids. Stapled haemorrhoidopexy is an alternative procedure to excision hemorrhoidectomy and is preferred due to less postoperative pain and suture less quick recovery procedure. 


However, in terms of cost, it exceeds the hemorrhoidectomy. In this procedure, a stapler cuts the circular section of the anal canal lining above the piles. This procedure pulls the piles back to the back passage and reduces the blood supply to the piles, which in turn causes shrinkage. In this procedure, hemorrhoidal tissue is kept in a ring of tissues with sutures after dilating with a dilator. Using a circular haemorrhoid stapler will remove haemorrhoids. Thereby, the blood supply is ceased. Fleet enema is administered on the morning of the surgery day.


Based on the surgeon's preference, it is done in lithotomy (the patient is placed supine with face up and arms to the side) or left lateral positions. It is an inpatient procedure performed under local, regional, or general anaesthesia.


Indications of stapled hemorrhoidopexy:

  • Grade-3 internal and prolapsed hemorrhoids
  • Piles with grade-2 which are not reduced in the previous sessions of rubber band ligation.
  • Grade-4 irreducible prolapse hemorrhoids.
  • Thrombosed internal hemorrhoids.

Contraindications of stapled hemorrhoidopexy:

  • Anal stenosis
  • Exteriorised rectal prolapse
  • Radiation proctitis (injury or damage to the rectum due to radiation)
  • Anal suppuration (anal abscess or pus)

Complications of stapled hemorrhoidopexy:

  • Rectovaginal fistula in females
  • Bacteraemia (presence of bacteria in the blood)
  • Rectal perforation (hole in rectum of large intestine)
  • Peritonitis (inflammation of the abdomen)
  • Pelvic sepsis (rare complication)

Haemorrhoidal artery ligation (HALO) for Piles / Hemorrhoids

Haemorrhoidal artery ligation operation and recto-anal repair (HALO-RAR) has two stages, and it does remove the hemorrhoidal tissues completely. This procedure treats bleeding and prolapsing haemorrhoids on both the internal and exterior sides. They are as follows:

  • Doppler-guided HALO (haemorrhoidal artery ligation operation): In this procedure, the haemorrhoidal artery is tied off, thereby cutting off the blood supply to the haemorrhoidal cushion.
  • RAR (recto-anal repair): This procedure uses plicating stitches to move the prolapsing portion of the haemorrhoid back into its proper location in the rectum.

Indications of HALO-RAR:

  • To treat recurrent symptoms after banding
  • To treat internal and external hemorrhoids with bleeding or prolapse

Contraindications of HALO-RAR:

  • Recent cardiac patients
  • Patients on anticoagulation therapy

Complications of HALO-RAR:

  • Mild bleeding 
  • Skin tags in occasional conditions
  • Pain on defecation (if dopplers are not used)

Preparation for the piles surgical procedure

  • The patient should fast for a few hours before piles surgery, as per the surgical gastroenterologist's recommendations. 
  • The patient will be administered a fleet enema several hours before surgery.

During the piles surgical procedure

  • During the hemorrhoidectomy, the surgeon will open the anus and cuts the haemorrhoids gently by using surgical scissors and remove the piles. After removing the piles, the surgeon closes the wounds with stitches or leaves open (open or closed hemorrhoidectomy) based on the patient's condition.
  • Based on the patient’s condition, the surgical gastroenterologist would like to prefer various procedures such as stapled hemorrhoidopexy, hemorrhoidal artery ligation, HALO-RAR etc.
  • During the hemorrhoidal stapling, the surgeon will perform this process by using a staple device to staple the piles into a normal position within the anal canal. This procedure restricts the blood supply to the piles and causes them to reduce size .
  • A proctoscope with a micro-Doppler probe is inserted into the anus during HALO. The haemorrhoidal artery close to the hemorrhoidal tissue is identified. Then the vessel is strangulated using a window (gap) on the proctoscope in the exact location.
  • The Doppler probe is taken out of the anal canal during RAR. The prolapsed haemorrhoidal cushion is stitched over its whole length using plication sutures. The prolapsed haemorrhoidal tissue is then drawn up by tightening these running stitches.

After the piles surgical procedure

  • Hospitalisation is needed for a few days following the surgery, as the gastro-surgeon advises.
  • The surgeon usually suggests some post-operative medications to treat post-operative symptoms.
  • The surgeon will suggest the preventive measures after the surgery before discharge.

Piles surgery recovery period or time

Recovery time after piles surgery varies from person to person based on the severity of the piles and the type of surgical procedure underwent.

  • Recovery time for rubber band ligation procedure: Usually, piles will drop off in between 3-10 days, and the patient may resume their normal activities.
  • Recovery time for injection sclerotherapy procedure: This procedure usually takes 1-2 weeks to treat the hemorrhoids; the patient may engage in their daily activities after the procedure whenever they feel comfortable (maybe the day after or after a few days). 
  • Recovery time for infrared coagulation procedure: The patient may return to normal activities within a few days, followed by the procedure.
  • Recovery time for the electrocoagulation procedure: Patients might be cleared of the condition after a single treatment and may resume normal activities on the same day.
  • Recovery time for the lord’s procedure: Patients are discharged after two days, followed by the procedure, and will be recovered in a few days.
  • Piles laser surgery recovery time: LHP is a less painful outpatient surgery with a shorter recovery period. The patient can restart their daily activities within a few hours of the surgery. Recovery time for piles laser surgery is very less when compared to other procedures.
  • Recovery from the surgical pile's procedure: This includes invasive procedures such as surgical hemorrhoidectomy, stapled hemorrhoidopexy and hemorrhoidal artery ligation. The piles stapler surgery recovery time, surgical hemorrhoidectomy and stapler surgery recovery time are almost nearer with few days of variation:
  • The procedures that restrict the blood supply to the piles require several days afterwards the surgery for hemorrhoids to fall off.
  • The wound can heal within 1-2 weeks after the surgery.
  • The recovery time for surgical procedures is 1 to 3 weeks from the day of surgery.

Preventive measures for piles

After surgery, there are some preventive measures for piles that must be taken into account:

  • As the surgeon may advise, hospitalisation is required for a few days.
  • To alleviate post-operative problems, the doctor typically recommends several post-operative drugs.
  • The doctor will advise accomplishing the following actions before discharging:
  • Refraining from straining while going to the toilet 
  • Staying away from frequent or strenuous lifting
  • Staying away from prolonged sitting
  • Consuming a diet high in fibre
  • Avoiding prolonged hours of sitting
  • Consuming lots of water
  • Taking a sitz bath

Advantages of Piles operation / surgery

There are a lot of advantages regarding the pile’s surgical procedures. The advantages of piles surgery vary from procedure to procedure due to differences in their principles. Advantages for various piles treatment procedures are as follows:

  • Rubber band ligation: Rubber band ligation is very effective and safe procedure with less severe complications and quick recovery.
  • Injection sclerotherapy: It doesn’t require hospitalisation. It is the best and safe technique when compared to other conventional procedures in terms of cost, recovery and side effects.
  • Infrared photocoagulation: Due to its less invasive nature, absence of serious consequences, and secondary bleeding, infrared photocoagulation is stated as a safer procedure than standard surgery with a quick recovery. There are no recurring costs other than the initial cost of the instrument.
  • Lord’s procedure: This is the manual procedure with less cost and low complications. 
  • Laser surgery or laser haemorrhoidoplasty: This is the best treatment for patients who are unresponsive to surgical procedures. The patient may engage in daily activities within a few days after the procedure. The patient might be suggested for discharge on the surgery day itself. There will be no postoperative complications such as severe bleeding and pain.
  • Invasive procedures: The invasive procedures such as surgical hemorrhoidectomy, stapled hemorrhoidopexy and hemorrhoidal artery ligation are the standard treatment procedures for piles due to the less recurrence. This procedure helps to remove hemorrhoidal tissue completely. These procedures are indicated to treat the piles with severe grades as well as prolapsed.

Disadvantages of Piles operation / surgery

The disadvantages of piles surgical procedures are as follows:

  • Rubber band ligation: Few minor complications such as pain, bleeding, and urinary retention are seen.
  • Injection sclerotherapy: Minor complications such as bleeding and clotting are seen. It is not recommended for the patients with inflammatory bowel disease, thrombosed hemorrhoids, and allergic patients.
  • Infrared photocoagulation: Except for minor complications such as mild bleeding, pain, itchy anus, etc., there are no major complications. Recurrence of piles may occur in some cases.
  • Lord’s procedure: Incontinence and pain are often seen after this procedure. It might not be apt in all cases.
  • Laser surgery or laser haemorrhoidoplasty: Laser surgery is expensive when compared to other traditional and conventional methods. It requires trained surgeons to operate the laser beam. There might be a chance of a recurrence of piles in the future.
  • Invasive procedures: Invasive procedures such as surgical hemorrhoidectomy, stapled hemorrhoidopexy, and hemorrhoidal artery ligation require a hospital stay of a few days when compared to non-invasive outpatient procedures. Major complications, such as severe pain, bleeding, infections, etc., are seen at the surgical site. The recovery time is longer (nearly 3 weeks) when compared to non-invasive procedures.

Frequently asked questions:

  • How to cure piles without operation?

    Piles or hemorrhoids can be cured in the early stages only. In the early stages, the patient can cure the piles by considering the lifestyle modifications, dietary and habitual changes. However, in severe stages or severe grades doctor/gastro surgeon suggests an operation or surgery.

  • When do piles need surgery?

    The doctor may recommend surgery for the patient whenever they are experiencing grade-3 or grade-4 hemorrhoids. The surgery needs anaesthesia prior to the procedure. It requires a hospital stay for some days after the surgery and to stay away from daily job or work activities for a few days.

  • Is piles operation painful?

    No, piles operation usually couldn’t cause pain. The piles surgery types include non-surgical, laser, and surgical procedures. Local, regional, or general anaesthesias are administered prior to the surgeries. However, the patients may not experience pain during the surgery due to the anaesthesia. Still, the patient experiences pain after the procedure (postoperative pain), especially in excision, minimally invasive and open surgeries. The gastro / interventional surgeon might recommend postoperative analgesics to treat that pain for a few days. 

  • Can 3rd degree piles be cured without surgery?

    No, Doctors usually advise surgery for those who have grade 3 or grade 4 haemorrhoids. However, occasionally, they may get cured naturally by changing their habits and lifestyle. Piles treatment without surgery is not possible in high-grade piles. 

  • Can piles recur after surgery?

    Yes, many studies have shown that there is a chance of recurrent piles or hemorrhoids in some cases due to lifestyle factors such as obesity, straining during bowel, pregnancy and failure of conservative therapies. 

  • Which type of operation is best for piles?

    Studies have shown that hemorrhoidectomy is the best procedure for treating severe piles or hemorrhoids due to the lowest recurrent rate. However, the surgeon suggests the surgery based on the piles type, severity, and patient's condition. 

  • What are the side effects of piles operation?

    The piles operation side effects may include pain, bleeding, constipation, faecal incontinence, and infections. Usually, they may occur in some cases only. 

  • How many days it takes to recover from piles operation?

    In most excision and open surgeries, the average person takes two weeks for recovery and off to work, although this varies depending on how the patient feels.


    The patient may gradually increase the level of regular activities. However, during the first week or second following surgery, the patient should avoid strenuous activities like lifting, exercising, or jogging. 

  • What to eat after piles surgery?

    After piles surgery, the gastro surgeon might suggest a fibre-rich diet, such as cereals, fruits, vegetables, beans, brown rice, legumes, peas, and liquids, including water and fruit juices, to reduce discomfort and pass the stool easier. 


  • Is laser operation good for piles?

    Haemorrhoidal laser procedure (HeLP) and laser haemorrhoidoplasty (LHP) are examples of non-excisional laser therapies that are secure and most effective. The surgeon considers them to treat piles with grades II and III that don't respond to conventional care. Usually, laser treatments are the best procedures when compared to traditional surgeries in terms of postoperative pain and length of hospital stay. The patient may engage in regular activities quickly with laser surgery.


    However, the gastrosurgeon / surgical gastroenterologist suggests the type of surgery based on the type and severity of piles/haemorrhoids. 

How much does piles surgery cost in Hyderabad, Telangana?

The average piles surgery cost in Hyderabad ranges varies from ₹ 55,000 to ₹ 75,000 (INR fifty-five thousand to seventy-five thousand). However, cost of hemorrhoids or piles surgery in Hyderabad depends upon the multiple factors such as patient age, condition, type of surgery (hemorrhoidectomy, rubber band ligation, sclerotherapy, and laser surgery) and CGHS, ESI, EHS, insurance or corporate approvals for cashless facility.

How much does piles surgery cost in India?

Piles surgery cost in India ranges varies from ₹ 45,000 to ₹ 90,000 (INR forty-five thousand to ninety thousand). However, cost of hemorrhoids or piles surgery in India may vary depending upon the different hospitals in different cities.