The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Haemorrhoidal artery ligation.


Haemorrhoids (also known as piles) are enlarged mucosal folds containing blood vessels in or around the lower part of the bowel (not inside the anus itself). They may cause itching, bleeding or pain.

Some types of surgery to treat haemorrhoids involve their removal and often result in pain after the procedure. This procedure is done on an area higher up in the bowel which is relatively less sensitive to pain. In this region, the blood vessels are tied and part of the inside lining of the bowel in the lower area is folded up reducing blood supply to the haemorrhoids and making them shrink inside the bowel. Since there is no excision of tissue, post-operative pain and complications are meant to be significantly lower than other surgical methods which involve the excision of tissue.

Coding and clinical classification codes for this guidance.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer. 

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)