HALRAR — haemorrhoidal artery ligation & rectoanal repair

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, a careful stitch is placed around it to tie it off. If any of your haemorrhoidal tissue has been slipping downward (prolapsing), additional stitches are used to lift it gently back up into its normal position — 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, there is no external wound to heal — which usually makes the recovery more comfortable than after a traditional haemorrhoidectomy.

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 without external wounds in a sensitive area — recovery tends to be more comfortable than after 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

• No external wound in a sensitive area — because nothing is cut away, there are no open wounds healing in a sensitive area, and recovery is typically more comfortable than after a haemorrhoidectomy
• No open wounds also means a lower risk of wound infection
• Effective for Grade II and III haemorrhoids — in published series, most patients have good symptom control at 1–2 years; recurrence over the longer term is around 10–20% at 2 years
• Faster return to your normal life — most people are back at work within 5 to 7 days
• The Doppler probe gives a precise way to locate every feeding artery — the position of each artery is heard, not guessed
• It tackles both problems in one operation: bleeding and prolapse, at the same time

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 — in published series, around 1 to 3 in every 10 patients may need further treatment within 2 years (more common in Grade IV/very large haemorrhoids). Whether this procedure is the right fit for your particular situation will be discussed at consultation.
• Mild discomfort and urgency — some aching and a feeling of needing the bathroom (called tenesmus) is normal for the first 3 to 7 days. 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.

If you take blood thinners, diabetes medication, GLP-1 weight-loss injectables, or iron supplements, please flag this when you book — these need specific adjustments before the procedure. Full details are in the guide above.

• You will need to complete a bowel preparation (a laxative-based clean-out) the day before your surgery. Our 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 the practice 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 consultation to go through all your questions and sign a consent form. Realistic success rates and how HALRAR compares to your other options will be explained, so you can make a confident, informed decision.

• You will be admitted to Warringal Private Hospital or Epworth Eastern on the morning of your surgery. 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.
• A small Doppler probe — think of it as a miniature listening device, the same technology as in an ultrasound scan — is used to find each artery that is feeding your haemorrhoids.
• Careful stitches are then placed around each artery to tie it off and stop blood flow to the haemorrhoid.
• If any tissue has been prolapsing (sliding downward), additional stitches are placed 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.

• 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 — do not 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.
• A post-operative review is routinely arranged 2 to 6 weeks after your procedure to check how you are healing and answer any questions you have — this review is provided at no charge.
• For day-by-day aftercare detail, see the Post-haemorrhoid surgery aftercare guide on the Resources page.

Post-operative concerns: Please call our rooms on (03) 9816 3951 and leave a message — this will be sent directly as a text to Mr Nguyen. Alternatively, you may text the office mobile on 0499 090 126. We aim to respond promptly during business hours.

Emergencies: For any life-threatening emergency, call 000 immediately or go to your nearest emergency department. Do not wait for a call back from our rooms. For the Austin Hospital Emergency Department: (03) 9496 5000.