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Transkaranielle Messung Intraoperativ Extrakranielle Messung Monitoring Funktionstest Dopplersonographie HAL Image Map Transcranial Operativ Excranial Monitoring Function Test Doppler Sonography HAL Image Map

The HAL method

 

A gentle procedure for the treatment of hemorrhoids

  • pain-free
  • without anesthesia
  • permanently symptom-free

 

The HAL procedure with the Hemo-Dop in medical practice

Author:
Prof. Dr. med J. Eitenmüller
Chief physician St. Rochus Hospital, Castrop-Rauxel
Doctor of surgery/vascular surgery/visceral surgery

With this procedure the artery supplying the hemorrhoid plexus can be tracked point by point, grasped using a special needle and ligated.
The specialized proctoscope with inlay is first lubricated well and then inserted. After the inlay is removed, a viewing window is opened. The proctoscope can then be twisted and pushed in and out of the anal canal and distal rectum with ease. It is also possible to see the mucosa passing the window.
The linea dentata can also be identified in this way. By moving the proctoscope, it is possible for the physician to have a good look at the anatomical structures.
After insertion of the proctoscope, using a circular motion, the physician can detect all the afferent arteries taking account of the hemorrhoid evidence, in order to gain a picture of the arterial supply in the individual case. At a minimum, the larger, clearly detectable arteries on the same side as the hemorrhoid must be ligated. It can be assumed that there is blood feeding transverse connections. Therefore, adjacent arteries must also be ligated.  
Moringa* reports on the treatment of 116 patients with episodes of anal pain, bleeding and prolapse without prior therapy using Doppler-guided RTN-ligature.
One month post-treatment 96% experienced no pain, 80% had no prolapse and 95% had no further bleeding. No serious complications were reported. Only 10% had minor symptoms when the proctoscope was inserted, 12% when performing the ligature and 12% after treatment. 12% of patients had minor bleeding after defaecation for one week. In the follow-up 5–12 months post-operatively only 3 cases had ongoing problems.
These findings are in accordance with my positive experience and in that of other colleagues in personal communication.

* Morinaga K, Hasuda K, Ikeda T. - 1995, A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with newly devised instrument (Moricorn) in conjunction with a Doppler flowmeter. Am J Gastroenterol. 90:610

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