One of the popular forms of surgery for hemorrhoids is the hemorrhoidal arterial
ligation operation known as HALO and as DG HAL (Doppler guided hemorrhoidal arterial
ligation) and recto-anal repair (HAL RAR). This is a recently FDA-approved operation.
It can be done with cutting or even a general anesthetic.
A Japanese surgeon, Kazumasa Moringa, tried using ultrasound or the Doppler technique
in 1995. This allowed for a visual of the hemorrhoidal arteries. The result was so
acceptable that the surgeon developed a surgical tool using a Doppler transducer
so that the problematic veins could be isolated.
Once the vein was located, the machine could tie off the hemorrhoid. This stops the
blood from flowing into the vein and it basically dries up and falls off.
It is a relatively simple procedure that can be carried out on an outpatient basis.
It depends on the intricacies of the hemorrhoids but often the surgery can be carried
out in about 20 minutes. You don’t need a lot of recovery time either.
The biggest side effect is the feeling that you have to have a bowel moment. This
might last for a day or so. There is minimal bleeding, if any. As with any hemorrhoid
surgery, there is always the possibility of infection, and incontinence.
There is something else that needs to be considered and that is just how advanced
your hemorrhoids are. There is a rating system in place and it relies on the level
of prolapse into the anal canal:
• Grade I hemorrhoids bulge out into the anal canal and may bleed.
• Grade II hemorrhoids bulge out of the anus when you strain to have a bowel movement
but they stop bulging outside when you stop straining.
• Grade III hemorrhoids pop outside of the anus on their own but can be shrunk back
inside with a basic treatment,
• Grade IV hemorrhoids prolapse and cannot be reduced. They combine internal and
external hemorrhoids and run the risk of thrombosis or strangulation.
There are some circumstances where the HALO type treatment is not recommended. For
instance, if the person has acute thromboses or blood clots in hemorrhoids or they
are on blood thinners, HALO is not recommended. Also HALO is not ideal for hemorrhoids
that are external.
This procedure has been studied quite a bit over the past 15 years and the results
are positive. The technique is easy for doctors to learn and carry out. It is an
outpatient technique and the ability to do this operation without anaesthetic is
a major benefit.
The success rate from a long term perspective is in the 90 percent and 100 percent
range. From a medical perspective, it is a time and money saver. The only material
used in the procedure is the suture thread. The only equipment is the ultrasound
device and the needle for the sutures. From the patient perspective these two factors
are also positive. The person can be back to work and regular life in a couple of
days rather than a couple of painful weeks.