PROCEDURES
Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) Procedure

Overview

Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) is an advanced, minimally invasive procedure that entails the use of a Doppler-guided probe to find and ligate arteries supplying blood to haemorrhoids. The procedure is completed in two stages to treat bleeding and prolapsing haemorrhoids without eradicating the haemorrhoid tissue.

Haemorrhoid Artery Ligation (HAL) is highly effective in treating signs of haemorrhoid disease such as:

  • Itching/bleeding in the anus
  • Pain
  • Swelling near the anus
  • Prolapsed IV-grade haemorrhoids

HAL-RAR Procedure

HAL-RAR, a two-stage procedure, involves the following:

  1. HAL Doppler-The handle of the proctoscope and micro-Doppler probe is placed through the rectum and gently rotated to locate all the arteries that supply blood to the haemorrhoid. An audible Doppler signal indicates the haemorrhoidal artery in close proximity to the haemorrhoidal tissue. After locating each artery supplying blood to piles, the arteries are tied off using stitches. Ligation occurs through an opening (window) in the exact position on the proctoscope.
    Ligations limit arterial blood supply, allowing the haemorrhoidal cushions to shrink to their regular size.
  2. Recto-anal repair (RAR)-In the event of a prolapsed haemorrhoid, Dr Singh removes the Doppler probe and lifts the drooping tissue by running a stitch from top to bottom and pulling the thread. Plication helps tighten and reduce the prolapsed mucosa and submucosa in its usual position.

Recovery after HAL-RAR

Over several days or weeks after the procedure, haemorrhoids begin to shrink, and symptoms dissipate. In most cases, patients can return to work within 24 to 48 hours after HAL-RAR with only slight discomfort or mild throbbing pain in the region.

Complications after HAL-RAR

Remarkably, Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) is free of major complications. A possible side effect is urinary retention. However, individuals may experience different responses to treatment. This information will be discussed in Dr Singh’s rooms prior to the procedure.

Source: Colorectal Surgeons Sidney, Doppler Guided Haemorrhoid Artery Ligation (HAL-RAR).

FAQ

How many arteries are found and ligated?
Typically, between 5 and 8 arteries can be found. However, this number varies from one patient to the next, depending on the severity of piles.
What are the benefits of HAL-RAR?
  • Less pain
  • No incisions
  • No open wounds
  • Speedy recovery
  • Quick return to work
What are the signs of a prolapsed haemorrhoid?
  • Pain during a bowel movement
  • Itching near the anus
  • Bleeding from the anal region
  • Full sensation in the rectum
  • Mucosal discharge from the anus
  • Swelling and inflammation in the rectum
 
 
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