Hemorrhoid treatment using the HAL-RAR method

Doppler-guided HAL-RAR dearterialization is a minimally traumatic method of treating internal hemorrhoids. HAL-RAR stands for hemorrhoidal artery ligation and recto-anal repair. The first part of the procedure — HAL — involves ligation of the hemorrhoidal arteries under Doppler control. The second part — RAR — is mucopexy, that is, tightening of the mucous membrane in case of prolapse of internal nodes. The HAL-RAR technique is also known as THD (transanal hemorrhoidal dearterialization) — transanal hemorrhoidal dearterialization.

Doctors of Oxford Medical explain: the technique is aimed at reducing the blood supply to hemorrhoidal nodes. The doctor, using a Doppler sensor, finds the arteries that feed the nodes and ligates them. As a result, the blood supply decreases, so the nodes gradually shrink, and the symptoms of hemorrhoids become less pronounced. The method does not involve classic excision of the nodes, so recovery usually proceeds more easily than after traditional surgery.

Dearterialization of hemorrhoidal nodes in Kyiv at the Oxford Medical clinic is performed by proctologists with many years of experience, who work in accordance with modern clinical recommendations. If you are concerned about bleeding, discomfort, prolapse of nodes, or other symptoms of hemorrhoids, do not postpone visiting a doctor — schedule a consultation at the Oxford Medical clinic at a time convenient for you.

Transanal hemorrhoidal dearterialization is most often used for internal hemorrhoids when the patient is concerned about bleeding, discomfort, a foreign body sensation, or prolapse of nodes.

Despite its minimally traumatic nature, the HAL-RAR technique is not suitable for all patients. Before the procedure, the doctor assesses the stage of hemorrhoids, the presence of concomitant diseases, the risk of complications, and the general state of health.

The main contraindications are:

• acute thrombosis of hemorrhoidal nodes;
• paraproctitis and purulent processes in the anorectal area;
• acute inflammatory diseases of the rectum;
• severe blood clotting disorders;
• decompensated cardiovascular diseases;
• acute infectious diseases;
• malignant neoplasms of the rectum.

In some cases, contraindications may be temporary. For example, in acute inflammation or thrombosis, medication treatment is first performed, and the issue of surgery is considered after stabilization of the condition.

If the HAL-RAR method is not suitable for the patient, the proctologist may recommend other treatment options — medication therapy, latex ligation, infrared coagulation, laser techniques, or classic hemorrhoidectomy, depending on the stage of hemorrhoids and the clinical situation.

Before HAL-RAR is performed, the patient needs to undergo a proctological examination and assessment. This allows the doctor to assess the stage of hemorrhoids, the condition of the internal nodes, and exclude possible contraindications to the procedure.

Preparation usually includes:

• anoscopy or rectoromanoscopy;
• general blood and urine tests;
• a coagulogram;
• ECG — according to indications, if sedation is planned;
• cleansing of the lower sections of the intestine before the procedure.

1–2 days before HAL-RAR, it is usually recommended to limit products that may cause bloating: legumes, cabbage, fresh baked goods, carbonated drinks, and alcohol. On the eve of the procedure, cleansing of the lower sections of the intestine is performed — most often using microenemas or special preparations for bowel preparation.

Before the intervention, the patient must inform the doctor about regular use of medications, especially anticoagulants, antiplatelet agents, and other medicines that affect blood clotting. If necessary, the doctor may temporarily adjust the regimen of their use.

The operation dearterialization of hemorrhoidal nodes is performed through the anal canal without external incisions. For the procedure, a special anoscope with a Doppler sensor is used, which helps find the arteries that feed the hemorrhoidal nodes.

The main stages of the procedure:

1. Patient preparation. The patient is placed in a comfortable position, the surgical area is treated with an antiseptic.
2. Anesthesia. The procedure is performed under local anesthesia or sedation (medicated sleep), depending on the extent of the intervention.
3. Insertion of the anoscope. The doctor inserts a special anoscope with a Doppler sensor to visualize the internal hemorrhoidal nodes and vessels.
4. Search for hemorrhoidal arteries. Using Doppler, the doctor determines the vessels that feed the hemorrhoidal nodes.
5. Ligation of vessels. The detected arteries are ligated to reduce blood inflow to the nodes.
6. Mucopexy — if necessary. In case of prolapse of internal nodes, the doctor performs tightening of the mucous membrane and fixation of tissues.
7. Control of tissue condition. After completion of the procedure, the doctor checks the intervention area and the absence of active bleeding.

After completion of the procedure, the patient usually stays in the clinic for some time under the supervision of medical personnel. In most cases, prolonged hospitalization is not needed, and it is possible to return home on the same day.

Transanal dearterialization of hemorrhoidal nodes belongs to minimally traumatic methods of hemorrhoid treatment; however, like any surgical intervention, it may have a risk of complications. The likelihood of their development depends on the stage of hemorrhoids, concomitant diseases, individual characteristics of the body, and adherence to recommendations during the recovery period.

Possible complications are:

• pain or discomfort in the rectal area;
• minor bleeding after the procedure;
• tissue swelling;
• temporary defecation disorders;
• thrombosis of external hemorrhoidal nodes;
• inflammation of the postoperative area;
• recurrence of hemorrhoid symptoms in the future.

Doctors of Oxford Medical explain: in the first days after the procedure, moderate discomfort or minor bloody discharge may be a variant of the norm. At the same time, in case of severe pain, heavy bleeding, fever, or pronounced deterioration of well-being, it is necessary to consult a doctor as soon as possible.

After HAL-RAR, recovery usually proceeds faster and easier than after classic operations with tissue excision. After the procedure, it is usually recommended to:

• temporarily limit heavy physical exertion;
• follow hygiene recommendations;
• take medications prescribed by the doctor;
• drink a sufficient amount of water;
• follow a diet with a sufficient amount of fiber;
• avoid strong straining during defecation.

After minimally invasive treatment, most patients can gradually return to everyday activity within a few days. At the same time, the period of complete recovery depends on the stage of hemorrhoids, the extent of the intervention, and the individual characteristics of the body.

For the HAL-RAR procedure, the price depends on the stage of hemorrhoids, the extent of the intervention, and the type of anesthesia. You can preliminarily familiarize yourself with the prices for medical services here. The doctor will guide you in more detail regarding the treatment method and cost after the examination and assessment. To schedule an appointment, contact the call center or use the online appointment form on the website.

The information is for informational purposes and does not replace a doctor's consultation.

Sources:

• American Society of Colon and Rectal Surgeons
• US National Library of Medicine
• National Institutes of Health