Treatment Duration
25 Minutes
------ To ------60 Minutes
Treatment Cost
₹ 23,000
------ To ------₹ 60,000
Book Appointment for Haemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR)
According to a study by Niranjan Agarwal et al., 2017, haemorrhoids are a common condition that affects about 50% of adults at some point in their lives. Haemorrhoidal artery ligation, or HAL, is a minimally invasive procedure to alleviate symptoms. This approach, combined with recto-anal repair (RAR), provides an effective solution with reduced pain.
HAL-RAR is a safe alternative to traditional haemorrhoidectomy. It offers patients a faster return to daily activities and long-term relief from discomfort. The following blog discusses the procedure, its benefits, risks, and recovery. Read on.
Procedure Name | HAL-RAR |
Alternative Name | HALO-RAR |
Conditions Treated | Haemorrhoids |
Benefits of the Procedure | Minimally invasive, outpatient procedure, low recurrence rate |
Treated By | Proctologist |
You can check Haemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR) Cost here.
HAL-RAR (Haemorrhoidal Artery Ligation and Recto-Anal Repair) is a minimally invasive surgical procedure for treating haemorrhoids (piles). It uses a Doppler ultrasound to locate the affected haemorrhoidal artery. The surgery combines two techniques:
Haemorrhoidal Artery Ligation: It causes the haemorrhoids to shrink back to their normal size by reducing their blood supply. This helps alleviate the symptoms of haemorrhoidal disease.
Recto-Anal Repair: For prolapsed haemorrhoids that protrude outside the anus, this step involves lifting and securing the prolapsed tissue back into place.
The rectum, which lies just above the anus, is the final five to six inches of the large intestine. The anus, which is 3-4 cm long, is the opening at the end of the digestive tract through which waste exits the body. It is surrounded by two muscle groups:
Internal anal sphincter (a ring of involuntary muscle).
External anal sphincter (voluntary muscle).
The function of the anus and rectum is as follows:
The rectum stores poop before it is expelled.
When the rectum is full, the internal anal sphincter relaxes, pushing poop toward the anus. The external sphincter allows voluntary control over when to release.
Haemorrhoidal artery ligation and recto-anal repair are effective treatment options for those with grade II and grade III haemorrhoids. The symptoms and conditions that may require an individual to undergo HAL-RAR include:
Proctitis (inflammation in the rectum)
Back pain from haemorrhoidal muscle pushing against the rectum
Constant anal itching
Piles that swell when sitting on hard surfaces
Rectal prolapse (the rectum slips out of the anus)
The HAL-RAR surgery is performed under general or spinal anaesthesia to ensure comfort during the procedure. It takes about 25-60 minutes to complete and includes the following steps:
Haemorrhoidal Artery Ligation: This procedure prevents the recurrence of piles by reducing blood flow. It involves the following:
A proctoscope with a Doppler ultrasound probe is inserted into the anus.
The probe handle is rotated to identify the arteries supplying blood to the haemorrhoids.
Using the guidance of the Doppler signal, the surgeon ties off each artery (ligation) with sutures to cut off blood flow. This causes the haemorrhoids to shrink.
Recto-Anal Repair: It is used after HAL in cases where piles have reached a severe stage. The process of RAR includes:
The handle of the device is placed in a similar position as for ligation. The ligation window is positioned to align with the prolapsed tissue.
The surgeon makes an initial stitch as high up in the anal canal as possible.
The handle is adjusted to make a series of stitches along the prolapse, spaced about 7-10 mm apart.
Next, the ends of the sutures are pulled and knotted together upwards toward the initial stitch. This method effectively lifts and secures the prolapsed hemorrhoidal tissue, restoring it to its proper position.
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Doctors give detailed instructions on preparing for haemorrhoidal artery ligation and recto-anal repair. Following these guidelines before and on the day of the procedure is essential to ensure the success of the surgery.
Patients meet their healthcare team two to four weeks before surgery for a pre-anaesthetic check-up. During this appointment, they also discuss other preparatory guidelines for the procedure. These include:
Parameters | Pre-requisites |
Pre-op Assessments |
|
Risk Evaluation |
|
Restrictions | Blood thinning medications 7-10 days before surgery |
Anaesthesia Selection | General or spinal |
Fasting | 6-8 hours before the procedure |
On the day of the procedure, patients should ensure that someone is available to drive them home after the surgery. Upon arrival at the hospital, they will be guided through the pre-operative process, which includes:
Parameters | Pre-requisites |
Consent | Mandatory |
Surgical Preparation | Changing into a hospital gown |
Physical Evaluation | Vitals check-up (blood pressure, oxygen, temperature, etc.) |
IV Line | Yes, for fluids and medications |
Patient Positioning | Lithotomy (lying on the back with legs elevated and supported in stirrups) |
Mild bleeding is common for four weeks after the procedure. Following the doctor’s instructions in the hospital and home can help ease recovery and relieve the symptoms.
Haemorrhoidal artery ligation and recto-anal repair is generally an outpatient procedure. This means that patients can go home on the same day. They are usually in the hospital for an average of 11 hours. During this stay, individuals can expect the following:
After the surgery, patients are taken to a recovery area where their vital signs, like temperature, pulse and blood pressure, are monitored until the anaesthesia wears off.
Pain medications are administered to manage discomfort.
Individuals can resume work in a week after HAL-RAR. Most patients can expect complete resolution of discomfort six weeks post-surgery. During this period, they are advised to follow these guidelines:
Rest for 24 hours after the procedure and restrict all physical activities.
Take sitz baths (a warm, shallow bath for the perineal region) 3-4 times daily after each bowel movement. It helps keep the anal area clean and relieve pain.
Initial bowel movements may cause some discomfort. Pain medications and stool softeners will help alleviate this.
Eat high-fibre food and drink lots of water (6-8 glasses daily) to prevent constipation.
The first follow-up visit is scheduled a week after the procedure to monitor healing and assess treatment success. The surgeon checks for any signs of infection or recurrence. The next visits are scheduled at 1 month, 6 months, 12 months, and then annually.
According to a study by Dr Amos et al., 2023, the patient satisfaction rate of HAL-RAR after six weeks post-procedure is 93.7%. The technique offers various benefits compared to traditional haemorrhoidectomy, which includes the following:
Minimally Invasive: It is less invasive than hemorrhoidectomy, reducing tissue damage and leading to faster recovery with less pain.
Outpatient Procedure: Haemorrhoidal ligation and recto-anal repair often allow patients to return home the same day.
Low Recurrence Rates: The risk of haemorrhoid recurrence one year after the procedure is 10.5%.
Quick Recovery: Most patients can resume activities like work within a week.
Haemorrhoidal artery ligation and recto-anal repair is a safe and effective procedure. However, like any surgical procedure, it has certain risks. According to a study by Turco and Trivedi, 2023, the complication rate after the procedure is 7.6%. These may include the following risks:
Bleeding
Infection
Dyschezia (difficulty pooping)
Urinary retention (temporary difficulty in urination)
Haemorrhoidal necrosis (death of tissue within haemorrhoids)
After undergoing HAL-RAR, patients should look out for any signs of complications. It is important to consult a doctor if they experience the following:
Intense pain that does not improve with medications
Excessive bleeding
Signs of infection like increased redness, swelling, and warmth at the surgical site
Fever above 101 F
Difficulty urinating
Delaying haemorrhoidal artery ligation and recto-anal repair can lead to several complications associated with the progression of haemorrhoidal disease. The following are some potential risks of postponing this treatment:
Haemorrhoids may increase in size and severity, leading to anaemia, pain, discomfort, and bleeding.
Advanced piles are more prone to complications such as thrombosis (blood clots within the haemorrhoid).
In extreme cases, untreated piles can lead to acute issues such as severe bleeding or strangulated haemorrhoids (blood supply to an internal haemorrhoid is interrupted). This requires emergency medical attention.
The haemorrhoidal artery ligation cost in India varies widely based on multiple factors. The price generally starts from ₹ 23,000, with an average figure of ₹ 45,000. The maximum expense is ₹ 60,000.
Procedure Name | Estimated Cost Range |
Haemorrhoidal Artery Ligation and Recto-anal Repair | ₹ 23,000 to ₹ 60,000 |
Note: These are estimated prices. For accurate costs, please speak to HexaHealth experts.
Factors that affect the price of surgery include:
Surgeon’s Fees: The medical expert’s experience and expertise can influence fees. Highly specialised surgeons often charge more.
Facility Charges: Private hospitals or surgical centres may be costlier than public facilities due to overhead expenditure and services provided.
Geographic Location: Expenses differ depending on the region or city due to variations in healthcare pricing and the cost of living.
Post-operative Care: Follow-up visits, medications, or additional treatments required post-surgery may add to the final bill.
Insurance: The extent of health insurance coverage and deductibles can significantly affect out-of-pocket costs.
Haemorrhoidal artery ligation and recto-anal repair is a modern procedure that treats haemorrhoids by targeting their blood supply and repairing prolapsed tissue. Its minimally invasive approach ensures a quick recovery, less pain, and minimal scarring. Patients benefit from precise treatment that significantly reduces the risk of recurrence.
HexaHealth provides comprehensive support for patients needing HAL-RAR, connecting them with experienced proctologists. Our network ensures personalised care from diagnosis to post-operative follow-ups. With us, you receive detailed guidance throughout your treatment for optimal recovery and improved quality of life. Get in touch today!
Rubber Band Ligation |
Perianal Abscess |
Non Surgical Treatment for Piles |
Sclerotherapy for Piles |
The HAL-RAR method (haemorrhoidal artery ligation and recto-anal repair) is a minimally invasive procedure for treating haemorrhoids. It combines artery ligation to cut off blood supply and recto-anal repair to reposition prolapsed tissue.
According to a study by Turco and Trivedi, 2023, the success rate of HAL-RAR surgery is 93%. About 85% and 92% of patients experience a reduction in symptoms within one month and 12 months, respectively. The exact rate varies based on the severity of the condition and adherence to post-operative care.
The HAL-RAR surgery is performed under general or spinal anaesthesia. It is a two-step procedure which involves the following:
HAL: A proctoscope with a Doppler ultrasound probe is used to locate and ligate haemorrhoidal arteries.
RAR: The prolapsed haemorrhoidal tissue is sutured and repositioned to restore proper anatomy and reduce prolapse.
In the HALO or HAL-RAR procedure, a Doppler ultrasound identifies the arteries supplying blood to haemorrhoids, which are then tied off. The surgeon also lifts and secures prolapsed haemorrhoidal tissue back into the anal canal. This reduces symptoms and improves healing.
Haemorrhoidal artery ligation is recommended for patients with internal or prolapsed haemorrhoids (Grades II and III). It is suitable for those who experience significant bleeding, prolapse, or discomfort and have tried conservative treatments. The procedure provides a less invasive solution with a high success rate.
The haemorrhoidal artery ligation cost can vary widely based on location, surgeon experience, and facility fees but typically ranges from ₹ 23,000 to ₹ 60,000. Patients are advised to consult HexaHealth experts for up-to-date pricing details.
HAL-RAR is particularly effective for patients with advanced haemorrhoid problems. It offers various benefits compared to traditional haemorrhoidectomy methods, which include the following:
Minimally invasive approach
Reduced pain and bleeding
Quicker recovery time
Lower recurrence rates
Haemorrhoidal ligation and recto-anal repair is generally considered a safe procedure. However, there are some risks associated with the surgery, which are as follows:
Bleeding
Infection
Urinary retention
Difficulty pooping
Recurrence of haemorrhoids
Recovery time for haemorrhoidal artery ligation is relatively short. Most patients can resume normal activities like work within a week. However, complete healing may take six weeks, depending on individual health and the extent of the procedure.
Post-operative care after HAL-RAR surgery is important to ensure the success of the process. It involves the following steps:
Managing pain with medications
Maintaining hygiene in the anal area
Following dietary recommendations to prevent constipation
Attending regular follow-up visits to ensure healing
HAL-RAR surgery is generally not performed under local anaesthesia. The procedure is done under general or spinal anaesthesia to ensure patient comfort.
You can resume normal activities within a week after HAL-RAR surgery, depending on the extent of the procedure and your overall health. Full recovery may take six weeks.
HAL-RAR surgery offers a long-term solution for haemorrhoids, but it is not guaranteed to be permanent. Healthy lifestyle choices and proper bowel management are essential to prevent recurrence.
The chances of recurrence after haemorrhoidal artery ligation and recto-anal repair are relatively low. According to a study by Lauricella et al., 2024, the recurrence rate one year after the procedure is 10.5%.
After HAL-RAR surgery, a high-fibre diet is recommended to ensure soft stools and regular bowel movements. This may include the following:
Fruits (pear, banana, orange)
Vegetables (broccoli, carrot, Brussels sprouts)
Whole grains (brown rice, barley, oats)
Nuts, seeds and legumes (lentils, almonds, chia seeds)
Avoiding acidic and spicy foods can also help minimise discomfort during recovery.
Yes, HAL-RAR surgery is performed as an outpatient procedure. Most patients go home the same day, which is convenient and reduces hospital stay costs.
Yes, there are alternative treatments available for HAL-RAR surgery, depending on the extent of the condition. These options include:
Pain medications to help relieve discomfort
Dietary changes like eating a high-fibre diet to avoid straining during bowel movements
Minimally invasive procedures like rubber band ligation and sclerotherapy
Surgery like haemorrhoidectomy and haemorrhoid stapling
More Treatment options
All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.
Last Updated on: 14 May 2024
MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES
12 Years Experience
Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More
She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More
Book Appointment for Haemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR)
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