Haemorrhoid surgery: HAL-RAR

Haemorrhoidal artery ligation with recto-anal reconstruction

Ligation of haemorrhoids with the Morinaga method (HAL-RAR)

The principle of the HAL-RAR operation(patient information from the manufacturer A.M.I. ), which originated in Japan, is to seek out the arterial inflow to the haemorrhoidal nodes with a special ultrasound probe and to stop it with sutures. This shrinks the haemorrhoids and reduces the tendency to bleed. The normal anatomy of the haemorrhoidal cushions is thus restored.

A.M.I. GmbH TRILOGY Animation - Explainer video for the treatment of haemorrhoidal disorders

Circular anal prolapse before HAL-RAR
Circular anal prolapse before HAL-RAR
Haemorrhoidal nodules in the proctoscope
Haemorrhoidal nodules in the proctoscope
Ligation and fixation of the haemorrhoid
Ligation and fixation of the haemorrhoid
Right: final state, left: tying "in progress


If there is a prolapse of the hemorrhoids at the same time, it can be gathered and fixed by a spiral continuation of the suture. The threads dissolve completely, leaving no foreign material behind.

Basically, haemorrhoids of stages I to III can be treated with this technique, serious risks are not to be expected. Due to the very good safety of the procedure, it has developed into the standard treatment of advanced haemorrhoidal disease in our proctological practice. Postoperative pain can be well treated by administering painkillers. In addition, treatment with LLLT and magnetic field treatment can accelerate the healing process and optimize the treatment result.

In cases of very voluminous haemorrhoids or a pronounced bleeding tendency, the additional sclerotherapy by laser probes inserted into the haemorrhoid nodes (laser haemorrhoidoplasty) has proven to be an excellent addition to the HAL-RAR procedure. Particularly in the early stages of haemorrhoidal suffering, this technique comes very close to the ideal of painless haemorrhoid surgery and can prevent the disease from progressing.

Only in the case of a very pronounced incident, which can only be postponed with difficulty, does one have to be aware of the limits of the HAL-RAR procedure. Despite the inevitable wound, laser hemorrhoidectomy is often the best choice in this situation.

Whichever method we choose together with you, we are experts in this field and bring with us many years of experience and expertise. Only about 10 to 20 percent of patients treated with HAL-RAR and/or laser haemorrhoidoplasty develop haemorrhoids again. In this case, conservative methods such as classical sclerotherapy are often sufficient, but HAL-RAR and laser haemorrhoidoplasty can also be used repeatedly.

HAL-RAR Bibliography

Xu, L., Chen, H., & Gu, Y. (2019). Stapled Hemorrhoidectomy Versus Transanal Hemorrhoidal Dearterialization in the Treatment of Hemorrhoids: An Updated Meta-Analysis. Surgical Laparoscopy Endoscopy and Percutaneous Techniques, 29(2), 75-81.


Specialists in surgery, proctology

Brienner Str. 13, D-80333 Munich, Germany

© 2021 Proctology Clinic Munich