DGHAL + RAR (Doppler Guided Haemorrhoidal Artery Ligation + Recto Anal Repair : DGHAL or HALO is performed under general anaesthetic. This operation is designed to eradicate piles without the need for cutting. The operation uses a miniature ultrasound device to locate the blood vessels supplying the haemorrhoids. The aim of the operation is to cut off the blood supply to the haemorrhoids. This is achieved by placing a stitch around each blood vessel. Over the following few weeks to months, the piles shrink away and the symptoms resolve. Some pain is to be expected for several days after the operation and this is usual.
Occasionally, for bigger haemorrhoids the surgeon may suggest a modification of the HALO procedure called RAR (Rectoanal repair). This is where further stitches are used to draw up larger haemorrhoids which may prolapse or hang down through the anal canal. These stitches are then tied to the original stitch, thereby hitching the haemorrhoid back into position and thereby encouraging it to shrink and hold back into position up inside the anus. While this procedure works well, the hitched stitches do cause some pain in the aftermath of the operation and normally we would advise you to have two weeks off work. The pain is still usually a bit less and with a quicker recovery than the alternative, which is a conventional open operation.
Excisional hemorrhoidectomy is a surgical excision of the hemorrhoid used primarily only in severe cases. It is associated with significant post-operative pain and usually requires 2–4 weeks for recovery. However, there is greater long term benefit in those with grade 3 hemorrhoids (Prolapse upon bearing down and requires manual reduction) as compared to rubber band ligation. It is the recommended treatment in those with a thrombosed external hemorrhoid if carried out within 24–72 hours. Glyceryl trinitrate ointment post procedure, helps both with pain and healing.
Stapled hemorrhoidectomy also known as stapled hemorrhoidopexy, is a procedure that involves the removal of much of the abnormally enlarged hemorrhoidal tissue, followed by a repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. It is generally less painful and is associated with faster healing compared to complete removal of hemorrhoids. However, the chance of symptomatic hemorrhoids returning is greater than for conventional hemorroidectomy and thus it is typically only recommended for grade 2 (Prolapse upon bearing down but spontaneously reduce) or 3 (Prolapse upon bearing down and requires manual reduction) disease.