[HAL-RAR for the treatment of hemorrhoids - a new, non invasive method]

Introduction: HAL-RAR is a new, minimally invasive technique for the treatment of haemorrhoids, whereby Doppler-guided ligation of the haemorrhoidal arteries (HAL) is combined with a mucopexy of the prolapsed haemorrhoidal tissue (RAR = Recto Anal Repair). Methods: We did these operations as an alternative to the conventional haemorrhoidectomies in the cases of grade III or - in some cases - grade II haemorrhoids. Between August 2017 and April 2019 a total of 45 patients were operated on with the HAL-RAR procedure. All operations were done under general or spinal anaesthesia. Results: Complications were seen in three patients within 30 days of surgery. One patient had proctitis, one patient suffered from a thrombosed haemorrhoid, while one patient had bleeding, which occurred on the 16th postoperative day. Two of them needed re-operation. Except one patient, all of them was treated in one-day surgery. HAL-RAR seems to be less painful than conventional procedures and causes more patient satisfaction in the early postoperative period. Neither the bleeding, nor the pain did not re-appear after 1 year, but one patient mentioned recurrence of the prolapse. Conclusion: Doppler-guided suturing is an effective, minimally invasive treatment option for even advanced haemorrhoidal diseases and seems to be ideal for one-day surgery.