Remarks and results from the use of the HAL/RAR technique in the management of patients with haemorrhoids
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To present the results of the DG-HAL/RAR technique (Doppler-Guided Haemorrhoids Artery Ligation/Recto-Anal Repair) in the surgical management of patients suffering from haemorrhoids, through the experience accumulated in our minimally invasive surgical unit.
Materials and Methods
Forty-two patients with a mean age of 35.6 years who underwent HAL/RAR repair during the past two years in our clinic were included in the study. Five patients had 2nd degree haemorrhoidal disease (11.90%), 19 presented with 3rd degree haemorrhoids (45.24%), and 18 suffered from 4th degree haemorrhoids (42.86%). Fifteen patients (35.71%) underwent general anaesthesia and 27 patients (64.29%) spinal anaesthesia. The A.M.I.. HAL-Doppler system was selected for the procedure since it detects haemorrhoidal arteries with the use of ultrasound.
Post-operative pain was present in only two patients and thus small doses of analgesia were administered (4.76%). A complication (regional haematoma) presented post-operatively in one patient, which was managed conservatively. All patients were hospitalized for 24 hours, with the exception of the patient with the haematoma, who was discharged 42 hours post surgery. Return to daily activity was accomplished 3–4 days post-operatively. The results were impressive, both immediately post-operatively and at the two-month follow-up. To date, no patient has displayed a haemorrhoid relapse.
The HAL/RAR technique is a versatile option for the treatment of haemorrhoidal disease, with minimal post-operative pain, virtually no complications, immediate return to daily activity, and satisfactory short- and long-term results.
Key wordsHAL/RAR haemorrhoids Doppler-guided ligation recto-anal repair
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