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Beverly Hills · 435 N. Bedford Dr., Suite 308Mon–Fri 9:00 am – 5:00 pmMost PPO insurance accepted
Allen KamravaMD · MBA · FACS · FASCRS

Procedure

Operative

Hemorrhoidal Artery Ligation / Doppler-Guided Ligation

A stitch-based procedure that uses Doppler ultrasound to find and tie off the arteries feeding the hemorrhoids — nothing is cut away, so recovery is gentler, with an honest trade-off on recurrence.

Request a consultationSurgery is arranged with a coordinator by phone.
Setting
Operative
Anesthesia
General or spinal anesthesia in the operating room, typically as a same-day procedure
Back to work
Usually quicker than after excisional surgery — there are no open wounds to heal; let comfort guide the pace
Pain relief
A dull ache or pressure sensation for several days rather than sharp pain — usually managed with sitz baths, stool softeners, and non-narcotic pain relievers
Success rate
85-95%
Recurrence
10-15%

What it is

What is Hemorrhoidal Artery Ligation?

Hemorrhoidal Artery Ligation (HAL), also known as Transanal Hemorrhoidal Dearterialization (THD), is a minimally invasive procedure designed to treat symptomatic internal hemorrhoids, particularly those that bleed or prolapse. The procedure uses a specialized proctoscope equipped with a Doppler ultrasound probe to precisely locate the terminal branches of the superior rectal arteries that supply blood to the hemorrhoids. Once an artery is identified, the surgeon places a suture around it to ligate (tie off) the vessel. This interrupts the blood flow, causing the hemorrhoid cushion to shrink and retract back into its normal position. If prolapse is a significant component, an additional running suture (rectoanal repair or mucopexy) may be placed to lift and fix the prolapsing tissue.

Am I a candidate?

Who is a Good Candidate for This Procedure?

This procedure is ideal for patients with symptomatic Grade II and III internal hemorrhoids who have not found relief with conservative treatments like dietary changes and fiber supplementation. It is particularly effective for patients whose primary symptoms are bleeding and prolapse. Because it does not involve excising tissue, it is generally associated with less postoperative pain than a traditional hemorrhoidectomy, making it a suitable option for patients who wish to avoid a more painful recovery.

How it's done

  1. 1You're asleep or numbed from the waist down — general or spinal anesthesia in the operating room.
  2. 2A special proctoscope with a Doppler ultrasound probe listens for each of the small arteries feeding the hemorrhoids.
  3. 3A dissolvable stitch ties off each artery, cutting the blood supply so the hemorrhoid cushions shrink over the following weeks.
  4. 4If prolapse is part of the problem, an extra lifting stitch (a mucopexy) pulls the sagging tissue back up into its normal position.
  5. 5No tissue is removed and there are no external wounds. Home the same day for most people.

What to expect

  1. Same day

    Home the same day, with no external wounds or dressings to manage.

  2. First days

    Expect a dull ache, rectal pressure, or a feeling of fullness rather than sharp pain. Sitz baths and simple pain relievers usually cover it. Trouble urinating can happen early on — tell us if it does.

  3. First week

    Soft stools are the job: fiber, fluids, stool softeners. Return to non-strenuous activity as comfort allows — most people are back to it quickly.

  4. Follow-up

    An office visit to confirm the hemorrhoids are shrinking and everything is healing as expected.

  5. Long term

    The honest number: in a large randomized trial of grade II–III hemorrhoids, about 3 in 10 patients (30%) had some return of symptoms within a year. Some need a repeat or a different procedure — we'll be candid about that up front.

Risks & considerations

What are the Risks?

While HAL/THD is a safe procedure, potential risks are possible, though they are less frequent and typically less severe than those associated with excisional hemorrhoidectomy. Risks include:

  • Pain and Discomfort: Most patients experience a feeling of rectal pressure or a dull ache for several days. Severe pain is uncommon but can occur.
  • Bleeding: Minor bleeding may occur, particularly a week or two after the procedure when sutures may dissolve. Significant bleeding requiring intervention is rare.
  • Urinary Retention: Difficulty urinating can occur in the immediate postoperative period, sometimes requiring a temporary catheter.
  • Thrombosis: A painful blood clot can form in an external hemorrhoid.
  • Infection: Though very rare, infection is a potential risk with any surgical procedure.
  • Recurrence: Hemorrhoid symptoms may recur over time, potentially requiring further treatment.

Sources

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