Haemorrhoidal arterial ligation and rectoanal repair. Read more below.

Haemorrhoidal arterial ligation and rectoanal repair (HAL RAR)

Haemorrhoidal Arterial Ligation – Recto Anal Repair (HAL-RAR) is a fairly new procedure with a long name, and we will call it HAL-RAR from here! 

HAL-RAR can be considered in two parts – the HAL, and the RAR. 

HAL stands for haemorrhoidal artery ligation. Under direct vision, or with a miniature ultrasound device, Dr Morris is able to accurately locate the arteries supplying blood to the problematic haemorrhoid.  

A stitch is placed around the artery to reduce blood flow, allowing the haemorrhoid to become less engorged, and less prone to bleeding, prolapse and irritation. 

The prolapsing component of haemorrhoids is dealt with via rectoanal repair, or rectoanal rectopexy (RAR). This results in a running stitch down the prolapsing face of the haemorrhoid, which is then tightened and lifted to its appropriate position in the anal canal. 

HAL-RAR is a better tolerated haemorrhoid operation than haemorrhoidectomy. It avoids the painful wounds, and risk of non-healing and bleeding that can occur with excision. Dr Morris will often discuss this operation with you if there are concerns around incontinence, a history of childbirth, or a history of other anorectal procedures. It is a lesser invasive option for haemorrhoids than the traditional painful treatments. 

HAL-RAR for many people can be painless, as most of the repair is performed above the level of nerve supply. However, pain can still occur in the first 1-2 weeks. There can be a sense of irritation or urge from the repaired tissue until the inflammation subsides. Given their is no excision, there may not be improvement to the external component, or skin tags, and the strategy for these will be discussed with Dr Morris to ensure a clear understanding and mutual decision on how to proceed. 

All haemorrhoid operations have a risk of haemorrhoids returning, and an adequate fibre and water intake, and managing constipation, avoiding straining, and time spent on the toilet can help reduce your risks. The recurrence rate with HAL-RAR is likely higher than excisional haemorrhoidectomy, but the latter comes with its own considerations. 

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