FGHAL – A Minimally Invasive Surgical Treatment for Piles

Piles, or hemorrhoids, are swollen veins in the anal and rectal region that can cause discomfort, pain, and bleeding during defecation. In early stages, piles can often be managed effectively with Ayurvedic or modern medicines. However, when medications fail to control bleeding or relieve symptoms, surgical intervention becomes necessary. One of the most effective and minimally invasive options available today is FGHAL (Finger Guided Hemorrhoidal Artery Ligation).

Understanding FGHAL Procedure

FGHAL is a modern technique similar to DGHAL (Doppler Guided Hemorrhoidal Artery Ligation). It focuses on identifying and ligating (tying off) the major arterial blood supply to the hemorrhoidal mass. By cutting off the blood flow, the pile mass begins to shrink, eventually resolving symptoms without any cutting or excision of tissue.

When is FGHAL Recommended?

• Persistent bleeding during bowel movements

• Painful internal piles unresponsive to medications

• Grade II or III hemorrhoids

• Recurrent piles not resolved with non-surgical treatments

Pre-Operative Preparation

Before undergoing FGHAL, patients must undergo standard pre-operative evaluations, including:

• Complete blood count (CBC)

• Blood sugar and viral markers

• Discontinuation of antiplatelet medications at least 5 days before the procedure (in consultation with a physician)

How FGHAL is Performed

• The surgery is performed in lithotomy position (legs raised).

• The anal canal is first examined and dilated using four fingers to facilitate palpation.

• The surgeon identifies the arterial base of the pile mass through manual palpation.

• Ligation is performed at three levels:

  • Base of the pile

  • Middle of the mass

  • Just above the dentate line (ligation below this should be avoided to reduce post-operative pain)

• The ligation is done using 0 no. chromic catgut or 2-0 vicryl suture.

• Multiple piles can be ligated in the same sitting depending on anal tone and tissue condition.

The procedure may be performed under local anesthesia or spinal anesthesia, depending on the patient's condition and surgeon's preference.

Post-Operative Care

• The patient can be discharged within 4 to 8 hours post-procedure.

• Prescribed medications include laxatives, anti-inflammatory drugs, and painkillers.

• Hot sitz baths are recommended to relieve discomfort.

• Patients are advised to:

  • Avoid straining during defecation

  • Spend minimal time in the toilet

  • Maintain a soft stool consistency

Complete recovery is usually seen within 21 days, with symptoms such as bleeding, pain, and swelling significantly reduced or completely resolved.

Benefits of FGHAL Procedure

• Minimally invasive (no cutting or excision)

• Almost no bleeding

• Less post-operative pain

• Daycare procedure – go home the same day

• Cost-effective

• Low risk of complications

• May be combined with laser therapy in selected cases for enhanced results

Conclusion

FGHAL is a highly effective, safe, and patient-friendly treatment for moderate to severe hemorrhoids. It avoids the discomfort of traditional surgeries while offering excellent outcomes. If you're suffering from persistent piles or bleeding, consult the experts at Bhardwaj Hospital, Varanasi, to know whether FGHAL is the right choice for you.