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HAL-RAR – Haemorrhoidal Artery Ligation and Recto Anal Repair – is a new form of treatment for all grades of haemorrhoids, which effectively targets symptoms and prolapse and causes patients only minimal – if any – pain.

Morbid changes in the anal region are becoming an increasingly widespread problem for the world’s population. Some 50% of people will suffer from haemorrhoidal disease at some stage in their life, however up until now, many of them have put off consulting their doctor because of the pain associated with the various treatment methods. Only now, after many years of stagnation in the development of surgical treatment for symptomatic haemorrhoids, are new alternatives being developed that are changing the status quo. Innovative new procedures such as HAL-RAR take away patients’ fear and ensure they visit a doctor in the early stages – in particular those doctors offering such effective and vitually pain-free treatment. So make the most of this new option for your practice or hospital!

HAL (Haemorrhoidal Artery Ligation)

The HAL method is suitable for treating low to medium grade haemorrhoids, and is extremely effective in addressing the symptoms of haemorrhoidal disease. The ligations serve to reduce the arterial blood supply, causing the haemorrhoidal cushions to shrink back to normal size. This method can be carried out with ease using the RAR Flexi Probe.

HAL_Doppler

  • The handle with the RAR Flexi Probe is introduced into the rectum, then rotated slowly to  search for arteries. The loudest Doppler signal indicates the centre of  the artery.
  • Once the first artery has been found, it is ligated using an A.M.I. Suture with 5/8 needle.
  • The handle is then turned again to locate further arteries. Once found, each artery is ligated as described in step 2.
As a rule, between five and eight arteries will be found during the procedure. However, this number can vary from patient to patient, and will also depend on the severity of the haemorrhoids in each case.

RAR (Recto Anal Repair)

The RAR method is used to treat the prolapsing haemorrhoids that occur during more advanced stages of the disease. RAR involves one or more mucopexies of prolapsing mucosa, carried out after the haemorrhoidal arteries have been ligated.

 

C-RAR-Flexi-Sonde

  • The handle is placed in the starting position as for ligation. The ligation window – and hence the handle – point towards the prolapse position requiring treatment.
  • First, an initial stitch is made as far proximal as possible. The  handle is then turned slightly to reveal more mucosa distally.
  • Now a running suture is started, and then continued with gradual turning of the handle, leaving 7 to 10 mm  between each stitch. After the last stitch, which ends proximal of the Linea Dentata, the needle is cut off and  the suture material knotted up near the initial stitch. This causes the prolapsing tissue to be pulled up towards the initial stitch, where it is then secured in place with a sliding knot.

New probe technology

The RAR Flexi Probe offers surgeons several key advantages for both the HAL and RAR procedures:

C-Neue-Sonden-Technologie

    1. New Doppler ultrasound technology:  quicker, more precise detection of arteries
    2. White sleeve: highly improved illumination
    3. 18% larger inner diameter at  the ligation window: easy, quick suturing

Advantages of  HAL and RAR

Since the introduction of these minimally-invasive methods, more than a hundred thousand patients have been treated with them and excellent results achieved in terms of effectiveness, patient-friendliness and safety.

Effective

  • Successful treatment of symptoms and prolapse. In a multicentric study comprising a total of 184 patients with high-grade haemorrhoidal disease in seven countries, 89% of all patients were completely free of symptoms after 12 months. *

Patient-friendly

  • No open wounds – minimal pain and a quick recovery. According to published data, these factors result in a high rate of patient satisfaction.**

Safety

  • Very few intra- or post-operative complications. Up until now, not one major complication has been reported in the literature.

Furthermore, the operation can be tailored to suit each individual patient.

* DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month, multi-centre, prospective observational study.
Roka et alEur Surg 2013; DOI 10.1007/s10353-012-0182-8
** DG-RAR for the treatment of symptomatic grade III and grade IV haemorrhoids: a 12-month, multi-centre, prospective observational study.
Roka et alEur Surg 2013; DOI 10.1007/s10353-012-0182-8
Doppler-guided haemorrhoidal artery ligation with recto anal repair: a new technique for the treatment of symptomatic haemorrhoids.
Forrest et al. Int J Colorectal Dis DOI 10.1007/s00384-010-0951-4
Doppler-guided hemorrhoidal artery ligation.

Scheyer et al. Am J Surg 191 (2006) 89-93

 

HAL-RAR Animated Videos

The nature of hemorrhoids

The Nature of Haemorrhoids

Treatment Options

Treatment Options

HAL

HAL

RAR

RAR

Advantages of HAL and RAR

Advantages of HAL and RAR

Order Code Product Technical Details

AHD 204

C-HAL-RAR-System-2 600

A.M.I. HAL-Doppler II System

Set consists of:

  • AHE 203   A.M.I. HAL-II Electronic System, incl. rechargeable battery
  • AHH 001  A.M.I. HAL Handle
  • AHK 007  A.M.I. HAL Knotpusher
  • AHN 006  A.M.I. HAL Needleholder
  • RAR2081  RAR Flexi Probe
  • AHAL 70  A.M.I. HAL Suture
  • AHA 00x  A.M.I. HAL-II Adapter (x = 1,2,3,4,5)
230 V adapter or battery operation
1 unit (385 mm x 140 mm x 260 mm)
2 handles
2 instruments
2 instruments
1 box
1 box
2 adapters

AHH 001

Handle heller

A.M.I. HAL Handle

Reusable aluminium handle for use with the A.M.I. HAL-II Electronic System and probes

1 handle
Delivered non-sterile, steam autoclavable

RAR2081

A.M.I. RAR Flexi Probe

RAR Flexi Probe

Disposable probe and sleeve set for performing HAL and RAR procedures.

Probe with asymmetric design for the gradual release of mucosa

5 sets / box
Delivered sterile

RAR2181

FlexiKit bearbeitet_small

HAL-RAR Procedure Kit Flexi

The kit consists of:

  • RAR Flexi Probe
  • A.M.I. HAL Suture (8)
  • Single-use knotpusher made of polycarbonate

For use with the A.M.I. HAL-Doppler II System (AHD 204)

1 set
Delivered sterile

AHN 006

AMI_0036 small TRILOGY

A.M.I. HAL Needleholder

Stainless steel needleholder designed specially to fit the ligation groove inside the A.M.I. probes

1 instrument
Delivered non-sterile, steam autoclavable

AHK 007

AMI_0038 small TRILOGY

A.M.I. HAL Knotpusher

Stainless steel knotpusher to facilitate knot tying inside the probes

1 instrument
Delivered non-sterile, steam autoclavable

AHAL 70

AMI_0040 small TRILOGY

A.M.I. HAL Suture

Suture material for HAL and RAR procedures

36 sutures / box
5/8 circle needle
Synthetic, absorbable, 2/0
75 cm long

 

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Literature Overview: abstracts