Surgical treatment for hemorrhoids - DG-HAL/RAR (THD)

Doppler-guided artery ligation (DG-HAL/HAL-RAR/THD)

DG-HAL/RAR (THD) procedure for treatment of hemorrhoids

The latest option for treatment of symptomatic hemorrhoids is the Doppler-guided arterial ligation. It was first described by Japanese scientists, but subsequently, the specific technique has been modified to utilize more advanced instruments. Unlike surgical hemorrhoidectomy, DG-HAL is a nonexcisional method that relies upon the Doppler device to detect the hemorrhoidal arterial flow. The surgeon can then ligate the branches of problematic hemorrhoids. Several ligations can be done in one sitting. This leads to a reduction in the size of the hemorrhoids. The suture is placed above the linea dentata and proponents of the procedure claim that it’s relatively painless for the patient.


Recently the method was modified to introduce suture hemorrhoidopexy (also mucopexy, RAR – recto anal repair), which helps fixate the redundant and prolapsing internal hemorrhoids. Thus, the procedure can be employed even in patients suffering from internal hemorrhoids in advanced stage (III-IV grade). The operative time is short and the utilization of the Doppler ultrasound probe allows the surgeon to be very precise, without inflicting much damage to the mucosa (or the internal sphincter). All this makes the procedure very safe and fairly popular these days. However, it is still an operative procedure that requires anesthesia (regional, local or general) and carries the usual risks – postoperative pain and bleeding, being the most common. The Doppler device is disposable and this increases the costs. Not enough long-term studies are available, but the limited data shows, that the procedure is reasonably effective, with 5-20% recurrence at 12 months.

HAL-RAR system set by A.M.I.
HAL-RAR system set by A.M.I. Image is courtesy to A.M.I.

HAL-RAR/THD recovery

For a smoother postoperative course, physicians will prescribe analgesics and might inject an anesthetic agent into the internal sphincter. You should stick to a high-fiber diet and drink plenty of fluids. Supplements, such as psyllium, can be useful in moderate amounts. You should be careful to avoid constipation and diarrhea. Normal activities could be resumed in about a week. Delayed bleeding could be presented, but severe bleeding should be discussed with the operating surgeon.

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