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Medical science has made rapid advances in the 21st century. It is no more confined to the art of making accurate incisions in the body to cure troubling diseases. Debilitating piles can be healed even without tearing your body. DGHAL-RAR is one such technique used to treat piles. Piles or haemorrhoids usually develop around the skin of the anus or near the rectum. Traditionally, open surgery was the only option to remove the mass accumulated in piles. But the new techniques aim at minimal invasion. Estimates show that around 10 million people suffer from the pain of piles in India annually.

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What is DGHAL-RAR?

DGHAL-RAR stands for Doppler- Guided Hemorrhoid Artery Litigation with Recto- Anal Repair. It is a medical technique used to detect the blood vessels supplying blood to haemorrhoids and cut the blood supply to eradicate the piles. An ultrasound device is used for this purpose. Doppler ultrasonography helps to estimate the amount of blood flowing through the vessels with the help of ultrasound waves that pass through red blood cells. Haemorrhoid Artery Ligation (HAL) was useful in treating piles during the initial stages. But in severe cases, it turned out to be ineffective. Therefore, a new technique called Recto-Anal Repair (RAR) was invented to intervene in those cases where piles had protruded out of the anus or rectum. RAR is performed in combination with HAL.

Why Does DGHAL-RAR Need to be Performed?

DGHAL-RAR is performed when piles begin to show their ugly face. Piles become painful when swollen. The patient starts to experience uneasiness during the excretion process. At times, chronic constipation leads to this situation. Irregular bowel habits, sedentary lifestyle, lack of exercise in daily routine and deficiency of nutritious food aggravate the condition.  Piles can also occur during pregnancy. DGHAL-RAR is particularly needed when bleeding during defecation becomes prominent. At this stage, immediate medical intervention is required.

What are the Symptoms Which Lead to DGHAL-RAR?

DGHAL-RAR is required when the patient begins experiencing the following symptoms:

  • ● Blood coloured stool
  • ● In extreme cases, the bleeding is so severe that it can also result in anaemia.
  • ● Pain while passing stool
  • ● Need to strain too much while passing stool
  • ● External Haemorrhoid- Swelling is quite visible outside the anus.
  • ● Itching and swelling around the anus
  • ● Discharge of mucus
  • Faecal Incontinence: It is a situation in which a person loses control over the excretory process. Usually, the patient is unable to determine when he/she should go to the toilet.
  • ● Incomplete excretory processes

How is the Need for DGHAL-RAR Diagnosed?

On witnessing any of the symptoms, the patient should immediately visit a doctor. The doctor may enquire about the bowel movements, the colour of stools and dietary habits.  External haemorrhoids can be detected easily through a physical examination of the anal area. Internal haemorrhoids require a digital rectal examination. The doctor can also examine the anal cavity using a proctoscope. Proctoscope is a medical device in the form of a hollow tube with a small bulb fitted at the end used for screening organs. Colonoscopy can also be recommended to eliminate the chances of other diseases associated with the digestive tract or excretory system. Once the case of piles gets established, the doctor will carry DGHAL-RAR.

How is DGHAL-RAR Performed?

DGHAL-RAR gets done with the help of a medical device called RAR Flexi Probe. It is inserted into the rectum to locate arteries. The point where the device makes the loudest sound is the centre of the problem. Similarly, other blood vessels are also recognised. A stitch is placed around each blood vessel responsible for the pile. As the source of blood vanishes, the piles begin to shrink. If the pile prolapses, a larger stitch is made and tied to the original stitch so that the haemorrhoid shifts to its original position. The pain is not as severe as in the case of traditional open surgeries.

What Are the Results Associated with DGHAL-RAR Treatment?

Depending upon the intensity of haemorrhoids, the number of arteries ligated vary between 4 to 8. It is advisable to follow the doctor’s instructions once the entire process culminates. Postoperative complications are lesser as compared to open surgeries. The doctor will prescribe medicines to deal with the pain after the operation. Change in dietary habits is usually required to prevent recurring piles. Thus, DGHAL-RAR is one of the best methods of dealing with haemorrhoids. Also, the patient recovers in a short passage of time.

What are the Risks Associated with DGHAL-RAR Treatment?

DGHAL-RAR delivers promising results. No serious risks are associated with the procedure. In addition, the chances of further rectal disturbances get significantly reduced. However, some patients can experience the following discomforts while DGHAL-RAR gets done.

  • ● Symptoms may take a longer time to subside completely.
  • ● Skin tags may be left behind.
  • ● Bleeding after the operation

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Is DGHAL-RAR Required if a Woman Suffers From Haemorrhoid During Pregnancy?

During pregnancy, Haemorrhoids occur due to increased pressure on the foetus. As a result, the blood flow also increases, and haemorrhoidal vessels enlarge. These symptoms subside after delivery. Therefore, DGHAL-RAR is performed in pregnancy very rarely.

How Long Does the Entire Process of DGHAL-RAR Take?

It takes around half an hour between anaesthesia and the end of the operation. However, it can stretch up to 75 minutes in some situations.

How Long Does it Take to Recover After DGHAL-RAR?

It takes around two weeks to return to your daily activity. If there is no postoperative bleeding, the recovery can be quicker.

Can Piles Burst During the Operation?

The purpose of the operation is to ensure that piles shrink away. When the blood clot develops inside the vein, it is known as a thrombosed haemorrhoid. Therefore, it is more susceptible to bursting. Also, these can cause severe pain and inflammation.

Can I Avoid Undergoing DGHAL-RAR and Leave the Piles Untreated?

Piles rarely vanish on their own. DGHAL-RAR is safe. There is no reason to escape the treatment and leave the situation to deteriorate. If piles are left untreated, these can even lead to anaemia due to severe bleeding.
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