Painless treatment of piles ; Stapler surgery and DG- HAL

Posted by Jhawar-Hospital on Sun, Jan 24, 2010  
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If Piles (hemorrhoids) are detected at an early stage it can be treated effectively without having to do open painful surgery. Many advanced minimally invasive techniques are available like stapler (MIPH) and ligation (DG HAL and HAL RAR) to provide permanent solution for piles with minimal discomfort, short hospital stay and quick recovery times.


Painless latest treatments for piles



DG HAL /HAL/HALO (Ligation of piles)

Doppler Guided Haemorrhoidal Artery Ligation (DG HAL) and Recto-Anal Repair (HAL RAR) or Hemorrhoid Artery Ligation operation (HALO) is a new FDA approved operation designed to eradicate piles without the need for cutting or a general anaesthetic.


DG HAL is particularly effective for Grade II and III haemorrhoids,

 It is coupled with Recto-Anal-Repair (HAL RAR) for some Grade III and most Grade IV haemorrhoids.

 This procedure has been performed in Europe, North America and U.K. now for a few years with excellent results.

DG-HAL Technique-


DG-HAL uses ultrasonic blood flow detector (Doppler) to identify the arteries supplying the piles. Surgeon ties these blood vessels by placing a suture around it through a small window in the device.

Tying off arteries that feed piles (hemorrhoids) causes them to shrink. It causes prompt resolution of most bleeding and protrusion caused by hemorrhoids, over next few days symptoms resolve completely.


Procedure can be done as an office procedure with or without any sedation or anaesthesia, or alternatively local rectal anaesthesia is given and nitroglycerin cream is applied to the rectum to enhance blood flow, making it easier to identify blood vessels.


 The procedure generally takes about 20-30 minutes, and Mild post operative Pain can be managed with simple analgesics. Patients can go home a few hours later.


Technique of DG HAL RAR


Through the window of device Recto-Anal- Repair (R.AR.) can also be done to reposition the prolapsed tissue.


 The device is so designed that only the prolapsing tissue is caught in the needle, hemorrhoids that are hanging down are lifted up to the place where they belong.. HAL-RAR takes Twenty minutes to complete. Most patients experience only minor discomfort and can return to work within one or two days.


 Benefit of DG HAL and HAL-RAR


_ No cutting and no open wounds

_ Short procedure time

_ Only one day in hospital

_ Back to work the next day

_ Very high success rates worldwide




 DGHAL is avoided for acute haemorrhoidal thromboses or clots, and patients on Coumadin or aspirin therapy (blood thinners).

Purely external hemorrhoids are not good candidates for DGHAL but must be excised.


Stapler Hemorrhoidectomy

Minimally invasive stapler hemorrhoidectomy (MIPH) is less painful and allows patients to return to work and other normal activities much earlier than with the conventional procedure.

This technique uses a stapling device.

The mucosa above the dentate line, which contains part of the pile mass, is excised and stapled with the stapler gun, thus taking care of bleeding and prolapse - the two major components of piles. The titanium staples cut and seal simultaneously, thus causing minimal bleeding and as the cut line is above the nerves, there is reduction in post operative pain. Additionally there is no incision on the perianal skin or lower part of anal canal there is no need to do any post operative dressing. It should be done by a surgeon who is especially trained in doing stapler surgery.


Advantages of Piles stapler surgery (MIPH)?

Smaller incisions resulting in reduced pain and discomfort
Minimal scarring
Greater surgical precision
Fewer complications
Less blood loss and a decreased need for blood transfusions
Reduced risk of infection
Shorter hospital stays
Faster recoveries

Risks involved

  Although rare, there are risks that accompany this procedure:


 Damage to the rectal wall.

The internal muscles of the sphincter may stretch, resulting in short-term or long-term dysfunction.

 Pelvic sepsis has been reported following stapled hemorrhoidectomy.

Persistent pain and fecal urgency after stapled hemorrhoidectomy



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