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HAL-RAR PROCEDURE
Hemorrhoidal Artery Ligation and Recto Anal Repair: It’s also called HAL-RAR. HAL-RAR is a hemorrhoid treatment technique in which the blood vessel supplying the hemorrhoid is ligated (tied off) to reduce blood flow and shrink the hemorrhoid without harming the anal tissue. The hemorrhoid will be smaller within 3–4 weeks. With the HAL-RAR technique, the patient needs only one day for recovery. Moreover, it could reduce the risk of complications, so there is no need to worry about side effects after treatment.
Operational technique – Hemorrhoidal Artery Ligation (HAL)
INSERTION OF THE speculum
An operating anoscope is introduced into the rectum and slowly rotated to search for arteries. A Doppler flow meter, if available, applied to the rectal area can help detect solid particles in circulating arterial blood and signal the arterial center.
hemorrhoid ligation
Once the first artery is found, it is ligated with a 5/8 needle, thereby compromising blood flow to the hemorrhoid.
ligation is repeated where needed
The handle on the operating speculum is then turned to locate further arteries. Once found, each artery is ligated, and the speculum is turned again. This must be repeated throughout the whole endolumen of the rectum, looking for abnormal hemorrhoid pathology with a voluminous blood supply.
Align the anoscope towards the prolapse
The operating anoscope's obturator is pulled back about an inch to create a window, unless, of course, you are already using a fixed window Doppler-integrated anoscope. Placed in the starting position for ligation. The ligation window - and hence the handle - points towards the mucosal prolapse position requiring treatment.
Make a cephalad stitch
An initial stitch is made as far proximal as possible. The handle is slowly rotated to open the ligation window further, revealing as much of the distally prolapsing mucosal tissue as possible.
A running stitch is then pulled and tied
A running suture is started and then continued with gradual rotation of the handle, leaving 7 to 10 mm between each stitch. After the last stitch, which ends proximal to the Linea Dentata, the needle is cut off, and the suture material is knotted up near the initial stitch. This pulls the prolapsing tissue up towards the initial stitch, which is then secured in place with a sliding knot.