Haemorrhoid artery Ligation operation (HALO) Also known as Doppler-Guided Haemorrhoidal Artery Ligation (DGHAL or HAL)

It was devised by Japanese surgeon Dr. Morinaga and reported on in 1995. This procedure seems to have the potential for revolutionising haemorrhoid treatments. It is an exciting and seems to be getting rave reviews regarding post op recovery time, pain and time spent in the hospital. The operation can be done as a day patient with the success rate being 95% effective two years on. The procedure itself takes 20 minutes it is also said to be very effective on bleeding hemorrhoids.

The Haemorrhoid artery Ligation operation (HALO) operation

The doctor who is performing the procedure will explain what they are going to do, and will ask for your written permission to perform the procedure. This procedure is performed on grade 2-4 haemorrhoids and according to NICE National Institute for Health and Clinical Excellence it is an effective alternative to haemorrhoidectomy

1. If you understand both what procedure you are going to have performed and have been told of the risks involved with the procedure then you sign the consent form
2. You will be asked to remove your clothes and put on a gown
3. Prior to going to theatre you will have discussed which anaesthetic is suitable for you with the anaesthetist.
4. You will be escorted to the theatre where you will then have either a general or spinal anaesthetic
5. You will be positioned either on the operating table with stirrups for your feet called the lithotomy position. Or on your front with your bottom raised it will depend on the location of the haemorrhoids. ( it will seem all a bit undignified but you will have either a sheet or blanket covering you until the procedure begins
6. You will have sterile drapes put over you to maintain a sterile field for the surgeon
7. An antiseptic/bacterial solution will be painted around the perineal area to eliminate germs from the skin surface
8. An instrument called a modified proctoscope will be gently placed in your anus so the doctor will be able to have a good view the haemorrhoids.
9. Local anaesthetic will be injected either before or after the operation depending on the type of anaesthetic you have been given.
10. The equipment houses a miniature Doppler transducer which is used to locate the blood vessels which are supplying the haemorrhoids.
11. The device has a small window which allows the surgeon to  place a suture (stitch) around the artery cutting off the blood supply to the haemorrhoid
12. If there are protruding haemorrhoids these will be drawn back inside the bowel and secured in place
13. An absorbent pad will be placed over the anus and a minor amount of bleeding may occur

Normal bowel habits should be resumed as soon as possible, and you will be encouraged to eat fibre rich foods and drink plenty of fluids. The first bowel movement is often dreaded due to pain however it is important that you open your bowels regularly to prevent constipation.

Post -operative pain

As there is no excision involved in this procedure therefore there are no wounds, general discomfort is the main problem but most people feel well enough to go home the same day.  

Special precautions

• Ensure you have adequate pain relief available to you; if you are uncomfortable ask the nursing staff for additional pain relief.
• Make sure you have someone available to help you at home when you are discharged form hospital for the next 24 hours
• Make sure you are able to urinate easily after the procedure(go for a wee) before you leave the hospital
• Maintain a good  fluid intake
• Try and do some gentle exercise, do not lie in bed or on the couch all the time
• Take any stool softener or laxatives you have been prescribed
• Eat plenty of fibre rich foods so you do not become constipated
• Do not do any heavy lifting for at least two weeks
• Maintain a good hygiene regime wash after each bowel movement

Healing / recovery time

Research has shown that recovery time is staggeringly good with people returning to work after 48 hours. The haemorrhoids shrink as the blood supply has been cut off

Complications and risks

• Pain - you may find that having your bowels open may continue to cause you pain
• Do not use aspirin for 3 weeks after the procedure as this is known to cause bleeding
• Return of the haemorrhoids – the operation may not be effective although it has a higher success rate than haemorrhoidectomy
• Inability to pass urine (wee)