HALRAR — Haemorrhoidal Artery Ligation & Rectoanal Repair

Overview

HALRAR — which stands for Haemorrhoidal Artery Ligation and Rectoanal Repair, and is pronounced "hal-rar" — treats haemorrhoids by cutting off their blood supply rather than cutting them out. Here is how it works in plain terms: a small Doppler probe (the same technology used in pregnancy ultrasound scans) is used to listen for the tiny arteries that are feeding blood to your haemorrhoids. Once each artery is located, Mr Nguyen places a careful stitch around it to tie it off. If any of your haemorrhoidal tissue has been slipping downward (prolapsing), he also stitches it gently back up into its normal position inside — this part of the procedure is called a mucopexy. Without their blood supply, the haemorrhoids naturally shrink away over the following weeks. You will be completely asleep under a general anaesthetic throughout. Because nothing is cut away, the great majority of patients find this procedure significantly less painful after surgery than a traditional haemorrhoidectomy.

Who needs this procedure?

HALRAR works best for a specific group of patients. You may be a good candidate if:

• You have Grade II or Grade III haemorrhoids — meaning haemorrhoids that come out when you strain but either go back in by themselves or with a gentle push
• Your haemorrhoids have not responded well to rubber band ligation
• You would prefer a treatment that tends to be less painful after the procedure than a full haemorrhoidectomy (surgical removal)
• You have haemorrhoids that bleed and also prolapse (slip downward)
• You take blood-thinning medication — HALRAR has a lower wound risk than excisional surgery, which can make it a safer choice in your situation

Benefits

• Considerably less pain after surgery than a full haemorrhoidectomy — because nothing is cut away, there are no open wounds healing in a sensitive area
• No open wounds also means a much lower risk of infection
• Good long-term success for Grade II and III haemorrhoids — more than 8 in every 10 patients are still symptom-free at 2 years
• Faster return to your normal life — most people are back at work within 5 to 7 days
• The Doppler probe gives Mr Nguyen a precise, reliable way to locate every feeding artery — nothing is guesswork
• It tackles both problems in one operation: bleeding and prolapse, at the same time

Risks & considerations

Every procedure carries some risk. We want you to feel informed and clear-eyed — not alarmed. Here is an honest summary of what to be aware of:

• Haemorrhoids can return over time — the chance of recurrence is higher than with full surgical removal, particularly if you have Grade IV (very large) haemorrhoids. Around 1 in 10 patients may need further treatment within 2 years. Mr Nguyen will talk you through whether this procedure is the right fit for your particular situation.
• Mild discomfort and urgency — some aching and a feeling of needing the bathroom (called tenesmus) is normal for the first 3 to 7 days. It is much less than what you would experience after a haemorrhoidectomy, and simple pain relief handles it well for most people.
• Bleeding — significant bleeding during the procedure itself is very rare (fewer than 1 in 100 patients). A small amount of bleeding around 7 to 10 days after surgery — when the internal stitches dissolve — occurs in about 2 to 3 in 100 patients. If this happens to you, please contact us straight away.
• Difficulty passing urine (urinary retention) — this occurs in about 5 to 10 in 100 patients in the first day or two after surgery. It usually settles on its own.
• Narrowing of the anal canal (anal stricture) — this is rare.
• A blood clot in an external haemorrhoid (thrombosis) — this occurs in about 3 to 5 in 100 patients. It is uncomfortable but almost always resolves without needing further surgery.

Before the procedure

• You will need to complete a bowel preparation (a laxative-based clean-out) the day before your surgery. Mr Nguyen's rooms will give you specific instructions on which preparation to use and exactly how to take it — a written schedule will be sent to you in advance.
• Stop anti-inflammatory pain medicines (NSAIDs such as ibuprofen, naproxen, or aspirin) as directed by Mr Nguyen's team in advance.
• Start stool softeners before your procedure — keeping your stools soft in the lead-up to surgery makes recovery more comfortable and less stressful.
• Before your procedure, you will have a detailed conversation with Mr Nguyen to go through all your questions and sign a consent form. He will talk you through the realistic success rates and how HALRAR compares to your other options, so you can make a confident, informed decision.

On the day

• Once you arrive and are settled in, the anaesthetic team will put you completely to sleep. You will not feel, hear, or remember anything during the procedure.
• Mr Nguyen uses a small Doppler probe — think of it as a miniature listening device, the same technology as in an ultrasound scan — to find each artery that is feeding your haemorrhoids.
• He then places careful stitches around each artery to tie it off and stop blood flow to the haemorrhoid.
• If any tissue has been prolapsing (sliding downward), he places additional stitches to lift and secure it back into its proper position (this is called a mucopexy).
• Some local anaesthetic is given before you wake up to help keep you comfortable in those early hours. You will then rest in the day-stay unit with nursing staff nearby.
• Most patients go home the same day, with a prescription for pain relief and stool softeners, and clear written instructions to take with you.

Recovery & aftercare

• Days 1 to 2: Plan to rest at home. A dull ache or pressure in the area is normal. Take your pain relief as prescribed — don't wait until the pain builds — and use the stool softeners provided.
• Days 3 to 5: The discomfort should be easing noticeably by now. You can start gentle walking and light activities around the house.
• Days 5 to 7: Most people feel well enough to return to a desk-based job by this point. If your work involves heavy lifting or physical activity, give yourself a little longer.
• By 4 weeks: You should be back to your full normal routine, including exercise.
• Long term: Eating plenty of fibre, drinking enough water each day, and avoiding straining at the toilet are the most important things you can do to reduce the chance of haemorrhoids returning. Your diet really does make a lasting difference here.
• Mr Nguyen routinely schedules a follow-up appointment 2 to 6 weeks after your procedure to check how you are healing and answer any questions you have. This review appointment is provided at no charge.

Related patient guides

We have written these guides especially for patients and their families. If you have questions about haemorrhoids or what to expect, these are a good place to start.