Traditionally, haemorrhiod surgery has involved excis
ing or cutting out the haemorrhoid which although effective is extremely painful with pain and discomfort lasting up to 4 weeks.
Newer methods such as HALRAR and selective stapled haemorrhoidecomy (see below) are newer techniques that are not only effective, can be performed as a day case ut mostly importantlly these procedures result in much less post operaive pain and discomfort.
HAL-RAR (Haemorrhoidal Artery Ligation and RectoAnal Repair) has an in-built miniature Doppler ultrasound device. This audible signal allows to pinpoint the exact location of the arteries supplying blood to the piles. Your surgeon then ties off each artery by placing a stitch around it and knotting the ends, hence cutting the blood supply to the pile. This is called ligation (HAL).
In the case of prolapsing haemorrhoids, your surgeon then runs a stitch from the top to the bottom and pulls the thread. This lifts up the tissue that is hanging down (RAR).
As a result, over the next few days and weeks the pile shrinks away and the symptoms resolve.
The ligation occurs in the lower rectum, where there are almost no pain nerves. Therefore, your doctor may perform the procedure under mild sedation. Naturally, patients who are squeamish about being awake during a procedure can elect to have a general anaesthetic.
Most patients are back to work after 24-48 hours with minimum discomfort. If there is any, it is no more than a mild throbbing in the rectum.
HAL-RAR has been performed in Europe and North America for many years with excellent results:
Although stapled haemorrhoid surgery has been around for some time, the first generation of staplers were somewhat unsatisfactory sometimes producing less than ideal results.
Using the newer TOUCHSTONE system a stapler is introduced into the rectum and sections of tissue above the haemorrhoids are excised. The technique is 'selective' in that the surgeon decides what areas of tissue are exicised, leaving healthy tissue behind and unharmed.
This technique is especially useful for larger troublesome grade 3 and 4 haemorrhoids (which protude and may need to be pushed in by the patient) . This also technique results in miminal pain and discofort compared to traditional surgery