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Colorectal · UK

Surgery for piles - the right procedure for your grade.

Band ligation, HALO (haemorrhoidal artery ligation), Rafaelo radiofrequency, stapled haemorrhoidopexy or excisional haemorrhoidectomy - the operation depends on the grade, not on the clinic. A consultant colorectal surgeon, honest pain-and-recovery numbers up front.

See indicative pricing
A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private haemorrhoid surgery costs in the UK.

Indicative ranges across our partner colorectal units.

In short

£3,200–£4,800, home home the same day.

Procedure Indicative range
Rubber band ligation (clinic, per session) £380–£680
Rafaelo radiofrequency (grade 1–2) £2,600–£3,800
HALO with Doppler-guided artery ligation £3,200–£4,800
Stapled haemorrhoidopexy (Longo) £3,800–£5,500
Excisional haemorrhoidectomy (Milligan–Morgan) £3,200–£4,800
LigaSure or Ferguson haemorrhoidectomy £3,600–£5,200
Colorectal consultation only £220–£380

Prices vary by hospital, consultant and approach.

The problem

The grade decides the operation. The clinic often decides the operation for you.

Piles surgery is where marketing has quietly outpaced the evidence - clinics sell one branded operation regardless of grade, and patients pay in pain and recurrence.

  • Match the operation to the grade

    Grade 1–2 do not need excisional surgery. Grade 4 will not be cured by banding.

  • Rule out the serious thing first

    Rectal bleeding is not always piles. A flexible sigmoidoscopy or colonoscopy is a small price for a definitive answer.

  • Tell you the truth about pain

    Excisional haemorrhoidectomy is genuinely painful for a week. HALO and Rafaelo are not. That matters to the choice.

When it helps

When surgery is the right step for piles.

The grades and situations we see most, plus the red flag that means a colonoscopy first.

  • Grade 1–2 bleeding piles

    Painless bright red bleeding on the paper or in the bowl, no significant prolapse - the classic banding or Rafaelo case.

  • Grade 2–3 prolapsing piles

    Prolapse on straining that reduces on its own or needs a push back - HALO with rectoanal repair or stapled haemorrhoidopexy.

  • Grade 4 permanent prolapse

    Piles that stay outside - excisional haemorrhoidectomy is often the only durable answer.

  • Thrombosed external pile

    Painful blue lump at the anal margin - a same-week excision or conservative pain control depending on timing.

  • Piles after previous banding

    Recurrent bleeding after two or three courses of banding - step up to HALO or excisional surgery.

  • Bleeding piles in pregnancy or post-partum

    Conservative first-line; banding or Rafaelo in selected cases. Excisional surgery avoided until at least 8 weeks post-partum.

  • Piles with anal fissure

    Combined operation - haemorrhoidectomy with lateral internal sphincterotomy or fissure injection, planned together.

  • Red flag: change in bowel habit or dark blood

    Change in bowel habit, weight loss, dark blood or iron-deficiency anaemia deserves a colonoscopy before any piles procedure - routinely, not later.

Procedure options

Approach depends on the grade - not the clinic.

Banding for early piles, energy or artery-ligation techniques for the middle grades, and excisional surgery for the advanced ones.

  • Rubber band ligation

    Simple clinic procedure for grade 1–2. Elastic band placed above the dentate line, pile sloughs off. Two or three sessions common.

  • Rafaelo radiofrequency ablation

    Radiofrequency probe under short block or GA. Excellent for grade 1–2 with less post-op pain than excisional surgery.

  • HALO (haemorrhoidal artery ligation)

    Doppler-guided ligation of the feeding arteries with optional rectoanal repair for prolapse. Grade 2–3. Very low pain.

  • Stapled haemorrhoidopexy (Longo)

    Circular stapler resects a ring of prolapsing mucosa. Grade 3. Fast recovery - but a slightly higher recurrence rate than excisional.

  • Milligan–Morgan excisional haemorrhoidectomy

    Open excisional operation - the definitive answer for grade 3–4. Painful for a week, but low recurrence.

  • Ferguson closed haemorrhoidectomy

    Closed variant of excisional operation - comparable outcomes, slightly quicker wound healing.

  • LigaSure haemorrhoidectomy

    Energy-device excision - less operative bleeding, comparable long-term result.

  • Combined operations

    Where piles coexist with a fissure or skin tag, we plan the combined operation on the same list.

Safety and recovery

What to expect afterwards - honestly.

Haemorrhoid surgery is well-established. The things worth planning are the grade match, the pain plan and the long-term diet.

  • Short GA or block, day-case

    Almost all haemorrhoid procedures are day-case. Banding needs no anaesthetic; the rest use short block or GA.

  • Bleeding - the main early risk

    Post-op bleeding at day 5–10 in 2–5 percent of excisional cases. Rest, avoid straining, come in for anything more than staining.

  • Pain after excisional surgery

    Genuinely painful for 7–10 days. Regular paracetamol, NSAIDs where allowed, stool softeners, sitz baths.

  • Urinary retention

    Common after excisional surgery, especially in men.

  • Anal stenosis

    Rare, more so after over-aggressive excisional surgery. Preserved skin bridges are essential.

  • Incontinence

    Rare after modern techniques; higher with older excisional operations or coexisting sphincter injury. Discussed pre-op.

  • Recurrence

    5–15 percent after HALO or stapled, 2–5 percent after excisional - dependent on lifelong fibre and hydration.

  • Infection and abscess

    Rare - under 1 percent. Fever or spreading redness needs the same-day team.

  • Red flags after surgery

    Heavy bleeding, spreading redness, unrelenting pain, urinary retention beyond 24 hours or fever - same-day team, or A&E.

Reading your operation note

Your piles operation note in four parts. Read the last one first.

Whichever technique was used, the note keeps to the same shape.

A UK colorectal surgeon reviewing an operation note

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the operation note and the histology before your review, just ask.

  1. 01 Header

    Grade, technique, side

    Grade of piles, the specific technique used and whether any coexisting fissure or skin tag was addressed.

  2. 02 Technique

    Positioning and closure

    Positioning, sphincter tone at exam, technique-specific details (staple line, ligation number, energy device).

  3. 03 Findings

    Anatomy and specimen

    Any coexisting pathology and, where excisional, the histology of the specimen.

  4. 04 Impression

    Pain plan and diet

    Read this first: pain plan, stool softener, sitz baths, and long-term fibre and hydration plan.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Haemorrhoid surgery is usually covered when medically indicated and after conservative treatment has been tried.

Frequently asked

Everything we get asked about haemorrhoid surgery.

Quick answers on grades, pain, recovery, recurrence and cost.

  • Which piles operation should I have?

    It depends on the grade. Grade 1–2 respond to banding or Rafaelo. Grade 2–3 do well with HALO with rectoanal repair or stapled haemorrhoidopexy. Grade 3–4 usually need an excisional operation. A named colorectal surgeon should be examining you before recommending anything specific - not a call-centre pathway.

  • Do I need a colonoscopy before piles surgery?

    If you are over 50, have a family history of bowel cancer, have changed your bowel habit, are losing weight, or have iron-deficiency anaemia, yes - a colonoscopy comes first. Rectal bleeding attributed to piles without a scope has led to missed cancer more than once.

  • How painful is haemorrhoidectomy?

    Honestly? Excisional haemorrhoidectomy is painful for 7–10 days, especially on opening the bowels. HALO and Rafaelo are much less painful - comparable to a mild sore throat. We tell you which is which before you consent.

  • How much does private piles surgery cost in the UK?

    Banding £380–£680 per session, Rafaelo £2,600–£3,800, HALO £3,200–£4,800, stapled £3,800–£5,500, Milligan–Morgan £3,200–£4,800. Combined operations add £600–£1,200.

  • How long is recovery?

    Banding and Rafaelo: back to work next day. HALO: back to office work at 3–5 days. Stapled: office work at 5–7 days. Excisional: office work at 10–14 days, no heavy lifting for 3 weeks. Full comfortable bowel opening at 4–6 weeks after excisional.

  • Will my piles come back?

    Recurrence is 5–15 percent after HALO and stapled, and 2–5 percent after excisional operations, and depends more on long-term fibre and hydration than on the operation. A recurrent pile is not a failed operation - it is a new pile in a bowel that has not been kept soft.

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