Doppler Guided Haemorrhoidal Artery Ligation (DG HAL) and Recto-Anal Repair (HAL RAR) or Hemorrhoid Artery Ligation operation (HALO) is a new operation designed to eradicate piles without the need for cutting or a general anaesthetic.

DG HAL is particularly effective for Grade II and III haemorrhoids,
It is coupled with Recto-Anal-Repair (HAL RAR) for some Grade III and most Grade IV haemorrhoids.

This procedure has been performed in Europe, North America and U.K. now for a few years with excellent results. 85% of patients have a complete resolution of their symptoms and over 90% are satisfactory results.

DG-HAL Technique

DG-HAL uses ultrasonic blood flow detector (Doppler) to identify the arteries supplying the piles. Surgeon ties these blood vessels by placing a suture around it through a small window in the device.

Tying off arteries that feed piles (hemorrhoids) causes them to shrink. It causes prompt resolution of most bleeding and protrusion caused by hemorrhoids, over next few days symptoms resolve completely.

Procedure can be done as an office procedure with or without any sedation or anaesthesia, or alternatively local rectal anaesthesia is given and nitroglycerin cream is applied to the rectum to enhance blood flow, making it easier to identify blood vessels.

The procedure generally takes about 20-30 minutes, and Mild post operative Pain can be managed with simple analgesics. Patients can go home a few hours later.

 
Benefit of DG-HAL

• Much simpler procedure and much faster recover time.
• As no incisions (cutting) are made it is relatively painless
• It can be carried out as a day care procedure.
• Procedure can be carried out without the need for general anaesthetic.
• High success rate

Technique of DG HAL RAR

Through the window of device Recto-Anal- Repair (R.AR.) can also be done to reposition the prolapsed tissue.

The device is so designed that only the prolapsing tissue is caught effect of lifting up the haemorrhoids that are hanging down. HAL-RAR takes Twenty minutes to complete. Most patients experience only minor discomfort and can return to work within one or two days.

 
Benefit of HAL-RAR

_ No cutting and no open wounds

_ Short procedure time

_ Only one day in hospital

_ Back to work the next day

_ Very high success rates worldwide

Preparation for procedure

On the day of you will be given enema or suppository for bowel preparation.
You will not be allowed to eat / drink 6 hours prier to surgery.
 

Post operative what to expect?

• You may have soft pad in place but no internal dressing
• You will be allowed to drink when you are fully awake.
• Usually no pain medication is required.
• You may feel the need to defecate frequently throughout the first 24 hours.
• There’s usually little or no postoperative bleeding, and return to work within 48 hours.
• Diet- Eat diet reach in fiber, drink 8-10 glasses of water.
• Activities- You can resume your routine activities and work same day. Avoid driving for 24 hours.
   

Limitation:

DGHAL is avoided for acute haemorrhoidal thromboses or clots, and patients on Coumadin or aspirin therapy (blood thinners).

Purely external hemorrhoids are not good candidates for DGHAL but must be excised.