Hemorrhoidal artery ligation (HAL), also known as transanal hemorrhoidal dearterialization (THD), is a surgical procedure used to treat hemorrhoids. Hemorrhoids are swollen blood vessels in the rectal area, which can cause discomfort, pain, and bleeding. HAL is a minimally invasive treatment option, especially suitable for patients with symptomatic internal hemorrhoids.

Procedure Overview:

  • The HAL procedure involves locating the arteries that supply blood to the hemorrhoids using a Doppler ultrasound probe.

  • Once these arteries are identified, they are ligated (tied off) to reduce the blood flow to the hemorrhoids, causing them to shrink.

  • The procedure is often combined with a mucopexy, a technique where the prolapsing hemorrhoidal tissue is lifted and repositioned to its normal anatomical location. This combination is sometimes referred to as HAL-RAR (Hemorrhoidal Artery Ligation and Recto Anal Repair).

Indications:

  • HAL is particularly indicated for patients with internal hemorrhoids, especially those that have not responded well to conservative treatments like diet changes, medications, or other less invasive procedures.

Advantages:

  • Minimally invasive with a lower risk of complications compared to traditional hemorrhoidectomy.

  • Generally associated with less postoperative pain and discomfort.

  • Quicker recovery time, allowing patients to return to normal activities sooner.

  • Can be performed under local anesthesia with sedation, regional anesthesia, or general anesthesia.

Effectiveness:

  • HAL is considered an effective treatment for hemorrhoids, with high success rates in reducing symptoms like bleeding and prolapse.

  • However, the long-term recurrence rate may be higher compared to more invasive procedures like hemorrhoidectomy.

Risks and Side Effects:

  • Potential risks include pain, bleeding, and transient urinary retention.

  • In rare cases, complications such as rectal perforation or infection can occur.

Postoperative Care:

  • Postoperative pain is generally mild and can be managed with over-the-counter pain relievers.

  • Patients are usually advised to consume a high-fiber diet, stay well-hydrated, and avoid straining during bowel movements to aid recovery and prevent recurrence.

  • Most patients can return to normal activities relatively quickly after the procedure.

Follow-Up:

  • Follow-up appointments are necessary to monitor healing and address any complications or recurrent symptoms.

HAL offers an effective and patient-friendly alternative to traditional hemorrhoidectomy, particularly for internal hemorrhoids. It's important for patients to discuss with their healthcare providers the best treatment option for their specific case, taking into account the severity of symptoms and individual health conditions.