Hellenic Journal of Surgery

, Volume 85, Issue 4, pp 274–279 | Cite as

Remarks and results from the use of the HAL/RAR technique in the management of patients with haemorrhoids

  • Christos Farazi-ChongoukiEmail author
  • G. Doulgerakis
  • A. Pantelis
  • M. Vidali
  • G. Papaioannou
  • C. Iordanou
  • I. Pougouras
  • L. Palyvos
  • I. Papandrikos
  • S. Pierrakakis
Retrospective Clinical Study



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 words

HAL/RAR haemorrhoids Doppler-guided ligation recto-anal repair 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Guttenplan M, Ganz RA. Hemorrhoids-Office Management and Review for Gastroenterologists. Touchgastroentorology. com; December, 2011.Google Scholar
  2. 2.
    American Gastroenterological Association Medical Position Statement. Diagnosis and Treatment of Hemorrhoids. Gastroenterology 2004;126:1461–1462.CrossRefGoogle Scholar
  3. 3.
    MacRae HM, Temple LKF, McLeod RS. A meta-analysis of hemorrhoidal treatments. Seminars in Colon & Rectal Surgery 2002; 13:77–83.CrossRefGoogle Scholar
  4. 4.
    Hardy A, Chan CLH, Cohen CRG. The Surgical Management of Haemorrhoids — A Review Dig Surg 2005; 22:26–33.CrossRefGoogle Scholar
  5. 5.
    SSAT Patient Care Guidelines Surgical Management of Hemorrhoids
  6. 6.
    Cataldo P, Ellis N, Gregorcyk S. Practice Parameters for the Management of Hemorrhoids (Revised). Dis Colon Rectum 2005; 48:189–194.PubMedCrossRefGoogle Scholar
  7. 7.
    Satzinger U, Feil W, Glaser K. Recto Anal Repair (RAR): a viable new treatment option for high-grade hemorrhoids. One year results of a prospective study. Pelviperineology 2009; 28:37–42.Google Scholar
  8. 8.
    Felice G, Privitera A, Ellul E, Klaumann M. Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum 2005; 48:2090–2093.PubMedCrossRefGoogle Scholar
  9. 9.
    Cirocco WC. Life threatening sepsis and mortality following stapled hemorrhoidopexy. Surgery 2008; 143:824.PubMedCrossRefGoogle Scholar
  10. 10.
    Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S. Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006; 191:89–93.PubMedCrossRefGoogle Scholar
  11. 11.
    Pescatori M, Aigner F. Transanal rectal mucosectomy ten years after. Stapled Tech Coloproctol 2007; 11:1–6.CrossRefGoogle Scholar
  12. 12.
    Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 2008; 12:7–19.PubMedCrossRefGoogle Scholar
  13. 13.
    Morinaga K, Hasuda K, Ikeda T. A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol 1995; 90:610–613.PubMedGoogle Scholar
  14. 14.
    Aigner F, Bodner G, Gruber H, et al. The vascular nature of hemorrhoids. J Gastrointest Surg 2006; 10(7):1044–1050.PubMedCrossRefGoogle Scholar
  15. 15.
    Schuurman JP, Go PMNYH, Bleys RLAW Anatomical branches of the superior rectal artery in the distal rectum. Colorectal Dis 2008 (Accepted Article).Google Scholar
  16. 16.
    Bursics A, Morvay K, Kupcsulik P, Flautner L. Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomized study. Int J Colorectal Dis 2004; 19(2):176–180.PubMedCrossRefGoogle Scholar
  17. 17.
    Wallis de Vries BM, van der Beeka ESJ, de Wijkerslootha LRH, etal. Treatment of Grade 2 and 3 Hemorrhoids with Doppler-Guided Hemorrhoidal Artery Ligation Dig Surg 2007; 24:436–440 (DOI: 10.1159/000108326)Google Scholar
  18. 18.
    Dorn HU, Mory M. 5 Years of HAL: Experience and Long-Term Results. A Prospective Study Coloproctology 2007; 29:205–210.CrossRefGoogle Scholar
  19. 19.
    Faucheron JL, Poncet G, Voirin D, Badic B, Gangner Y. Doppler-guided hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) for the treatment of grade IV hemorrhoids: long-term results in 100 consecutive patients. Dis Colon Rectum 2011; 54(2):226–231.PubMedCrossRefGoogle Scholar
  20. 20.
    Faucheron JL, Gangner Y. Doppler-guided hemorrhoidal artery ligation for the treatment of symptomatic hemorrhoids: early and three-year follow-up results in 100 consecutive patients. Dis Colon Rectum 2008; 51:945–949.PubMedCrossRefGoogle Scholar
  21. 21.
    Greenberg R, Karin E, Avital S, Skornick Y, Werbin N. First 100 cases with Doppler-guided hemorrhoidal artery ligation. Dis Colon Rectum 2006; 49:485–489.PubMedCrossRefGoogle Scholar
  22. 22.
    Felice G, Privitera A, Ellul E, Klaumann M. Doppler-guided hemorrhoidal artery ligation: an alternative to hemorrhoidectomy. Dis Colon Rectum. 2005; 48(11):2090–2093.PubMedCrossRefGoogle Scholar
  23. 23.
    Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S. Doppler-guided hemorrhoidal artery ligation. Am J Surg 2006; 191:89–93.PubMedCrossRefGoogle Scholar
  24. 24.
    ASCRS Poster. Minimally Invasive Hemorrhoid-ectomy: Results of DG-HAL and Sutured Hemorrhoidopexy.Google Scholar
  25. 25.
    Zagryadkiy EA, Gorelov SI. Transanal doppler-guided hemorrhoidal artery ligation / recto anal repair (HAL-RAR.) for treatment of Grade 3–4 hemorrhoids: a new mini-invasive technology. Pelviperineology 2008; 27:151–155.Google Scholar
  26. 26.
    Cho SW, Lee RA, Chung SS, Kim KH. Early Experience of Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal Repair (DG-HAL & RAR) for the Treatment of Symptomatic Hemorrhoids. J Korean Surg Soc 2010; 78:23–28.CrossRefGoogle Scholar
  27. 27.
    Jeong JW, Cho SW, Noh KT, Chung SS. One Year Follow-up Result of Doppler-guided Hemorrhoidal Artery Ligation and Recto-Anal Repair in 97 Consecutive Patients. J Korean Soc Coloproctol 2011; 27(6):298–302PubMedCrossRefGoogle Scholar
  28. 28.
    Norden J, Hanallah R, Getson P, et al. Reliability of an objective pain scale in children. J Pain and Symptom Management 1991; 6:196.CrossRefGoogle Scholar
  29. 29.
    Coll AM, Ameen JR, Mead D. Postoperative pain assessment tools in day surgery: literature review. Journal of Advanced Nursing 2004, 46:124–133.PubMedCrossRefGoogle Scholar
  30. 30.
    Mackintosh C. Appraising pain. In Banks C, Mackrodt K (Eds) Chronic Pain Management. Whurr Publishers, London, 2005, pp. 92–112.Google Scholar

Copyright information

© Hellenic Surgical Society 2013

Authors and Affiliations

  • Christos Farazi-Chongouki
    • 1
    • 2
    Email author
  • G. Doulgerakis
    • 1
  • A. Pantelis
    • 1
  • M. Vidali
    • 1
  • G. Papaioannou
    • 1
  • C. Iordanou
    • 1
  • I. Pougouras
    • 1
  • L. Palyvos
    • 1
  • I. Papandrikos
    • 1
  • S. Pierrakakis
    • 1
  1. 1.Department of SurgeryThriassio General HospitalAthensGreece
  2. 2.Alimos AthensGreece

Personalised recommendations