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Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR)

There is some important information about the pre-operative preparation for this procedure. It is imperative that you read this.

Read about Anorectal Pre-operative Preparation

The Haemorrhoidal Artery Ligation and Recto Anal Repair Procedure

The HAL-RAR procedure is the ideal procedure for the treatment of symptomatic haemorrhoids that have not responded to conservative management namely optimisation of a high fibre diet and regular bowel habit. The principle of the operation is to reduce the inflow of blood into the haemorrhoidal plexus by identifying the individual haemorrhoidal arteries using a special Doppler ultrasound probe and ligating it with a suture. All of the haemorrhoidal arteries are located in turn and ligated. In practical terms this is usually six to nine arteries. The second part of the procedure is to correct the attendant prolapse of the relevant haemorrhoidal sector and this is achieved once again using a plication suture which in the process of tightening reduces the prolapsed mucosa and submucosa into its original position. Whilst the healing process is reasonably quick the long term result is not achieved until approximately twelve week post operatively.

Usual Medications

Any medications that are taken routinely should be taken on the day of the procedure with a sip of water unless otherwise specified. Any anti-coagulant therapy should be ceased in accordance with instructions once again issued at the time of booking the procedure.

Hospital Stay

Most procedures are performed as a day case, unless there is a special requirement for an overnight stay or if this is the preference of the patient.

Anaesthesia

The procedure is performed under general anaesthesia.

Complications

The Haemorrhoidal Artery Ligation and Recto Anal Repair procedure is remarkably free of complications. The most predominant one is urinary retention. The mechanism is poorly understood. It is more likely to happen in elderly males who have a degree of prostate enlargement and therefore a predisposition to urinary retention. The nursing staff will ensure that you are able to pass urine freely before discharge. However having achieved this there is the possibility that you may go into retention whilst at home. If you get the sensation that you want to urinate and are unable to do so to the point of discomfort then you should contact Dr Renaut’s office without delay. If this is out of hours an answering machine will inform you of Dr Renaut’s out of hours contact procedure. Complications such as infection and bleeding are most unusual. Certainly if you feel unwell and have a fever in the immediate post-operative period or if you experience excessive bleeding then once again contact Dr Renaut’s office without undue delay.

Long Term Results

The result of the HAL-RAR procedure are generally excellent in that the majority of patients experience complete relief of the haemorrhoidal symptoms once they have recovered from the operation itself which will take a few days. You will see some improvement straight away but then you will see some ongoing improvement until the final result is reached at approximately the twelve week stage.

For further information about what to expect in the post-operative period please see the relevant section of the website.

Procedure Video Description


Post-operative Care following a Haemorrhoidal Artery Ligation and Recto Anal Repair Procedure

Following a Haemorrhoidal Artery Ligation and Recto Anal Repair procedure it is important that you are aware of the expected post-operative course we describe is designed to help you reduce the chance of experiencing negative effects from the procedure.

Post-Operative Pain

It is inevitable that you will experience a degree of pain in the post-operative period. Long acting local anaesthetic will have been injected in the operative area and the effects of this will last approximately eight hours. It is important that you have the prescribed analgesia on board before this point is reached. You will be sent home with a prescription for Endone which is a morphine derivative. This should be taken as instructed. If you find that one tablet taken every three to four hours is insufficient then the dose can be doubled. In addition to Endone, you can also take Panadol or Nurofen concurrently once again following the usual instructions pertaining to these medications.

Whilst Endone is an excellent pain killer it has the unfortunate side effect of causing constipation and to counter this you will be sent home with a prescription for Coloxyl 120mg to be taken twice a day. This is a stool softener and should be taken regularly for the first few days and certainly until the bowel function returns to some form of regularity. The discomfort you will experience is typically in the form of a deep seated sensation akin to having a full rectum. This will give you the sensation of wanting to have your bowels open but in fact there won’t be anything in the rectum that needs to come out. If you can dispense with the Endone on the second post-operative day and restrict yourself to either Nurofen or Panadol so much the better as the latter will not have a constipating effect. However if you need to continue with Endone please feel free to do so. If you experience some discomfort that does not respond adequately to a regular dose of Endone then call the office without undue delay.

Difficulty with urinating

For reasons that are poorly understood, a few patients undergoing a HAL-RAR have difficulty passing urine after the procedure. The nursing staff will ensure that you are able to do so before leaving the hospital but you can nevertheless block off after getting home. Try a warm shower but If you get to the point where it is becoming very uncomfortable then call Dr Renaut’s office (after hours there will be an answering machine that will give out contact details).

Bowel Function

Your bowels will probably not work until the second post-operative day so do not be alarmed. If they have not worked by the third post-operative day then give yourself a microlax enema and repeat this every few hours until the bowel does start to work. Bowel function initially will be erratic and will take several days and sometimes a few weeks to settle into its normal routine.

Resuming Normal Activity

Common sense dictates how much you activity you should do in the first few days after your surgery. It is important that you rest to give your body time to heal. Increasing your activity too early is likely to cause an increase in your discomfort level. Generally you should have a few days off after the surgery and some people require a whole week. It would be advisable not to do any heavy lifting for at least two weeks and then to reintroduce gradually. This includes activities such as running, cycling and going to the gym.

Diet

You cannot stop your bowel working and abstaining from food all together will have little effect on bowel function. It is important to take some nutrition in the post-operative period and in fact you are not required to alter your diet in any special way in this regard.

Follow up

Dr Renaut prefers to see his patients for a post-operative review of the Haemorrhoidal Artery Ligation at approximately eight weeks. If however you feel that this is not required then he would be happy for you to make a phone call to the office to this effect.

Other Procedures

If you wish to ask Dr Renaut about any related procedures such as a colonoscopy or gastroscopy, you may do so in the initial consultation.

Related Information

Read about Haemorrhoids