.
Doppler-guided haemorrhoid artery ligation (HAL) involves the use of a doppler ultrasound device to identify the arterial vascular pedicle, which is then tied off with a stitch. This reduces blood flow to the haemorrhoid, which stops troublesome bleeding and can over time shrink the size of the haemorrhoid. It is suited for internal haemorrhoids that cause troublesome bleeding and has the benefit of being minimally invasive and relatively painless.
Recto anal repair (RAR)
A doppler-guided Recto Anal Repair (RAR) (also called haemorrhoidopexy) involves that placement of a running suture along the length of the prolapsing haemorrhoid, which is then tied snug, thereby pulling the prolapsing haemorrhoid back up into the upper anal canal. It usually follows haemorrhoid artery ligation (HAL) if prolapse of the haemorrhoid is present.