Concierge coloproctology · UK
Haemorrhoidal artery ligation (HAL), by a consultant coloproctologist.
A Doppler-guided, suture-based alternative to a formal haemorrhoidectomy — much less pain, back to work in a week, and the anaesthetic option that suits you.
Why patients choose us
- 01
A consultant colorectal surgeon, in theatre
Not a proctology drop-in and not a training room. A named coloproctologist, a proper theatre, and the anaesthetic that suits you.
- 02
Less painful alternatives on the table
For some patients banding, a laser haemorrhoidoplasty or a formal Milligan–Morgan is the better answer. We say so before you commit to HAL.
- 03
Independent, and free
We are paid by no clinic, so the recommendation is impartial and costs you nothing.
Indicative pricing
What a private HAL costs in the UK.
Indicative ranges across our partner clinics. Send the details and we quote firm figures across two or three options.
In short
A HAL under LA and sedation in our network: £2,200–£3,200, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| HAL under LA and sedation | £2,200–£3,200 | 30–45 min | Same visit |
| HAL under spinal | £2,600–£3,600 | 45 min | Same visit |
| HAL under GA | £2,800–£4,000 | Half-day | Same visit |
| HAL with rectoanal repair (RAR/mucopexy) | £2,800–£4,200 | 45–60 min | Same visit |
| Rubber band ligation (for context) | £350–£700 | 15 min LA | Same visit |
| Coloproctology consultation only | £200–£400 | 30 min | Same visit |
Prices vary by clinic, by which coloproctologist does the case, by the anaesthetic chosen, and by whether a mucopexy or skin-tag excision is added on the day. We come back with a firm quote within one working day.
The problem
The right surgeon, the right anaesthetic, the right procedure.
Piles are quietly one of the most poorly managed problems in private surgery — banding done for prolapse it cannot fix, or a full Milligan–Morgan done when HAL would have worked. We stop that.
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Not sure it is needed?
Fibre, hydration and topical treatment done properly for a few weeks fix a lot of Grade I–II piles. We say so before you agree to surgery.
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Worried about pain?
HAL avoids the raw wounds of a Milligan–Morgan. LA and sedation, spinal or GA — you pick, informed by an anaesthetist.
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Want it done properly?
A named consultant coloproctologist, a proper theatre, and Doppler-guided ligation to NICE IPG525 standard.
The journey
From enquiry to recovery — what happens, in order.
One clinician from first message to review — including the recovery window.
Phase 1 · Before your procedure
Concierge, off-stage for you
Phase 2 · On the day
A few hours at the clinic
Phase 3 · After
Concierge, back on
- 01
Before
You tell us what is going on
A short, confidential form. Bleeding, prolapse, how long, what has already been tried — banding, creams, fibre.
- 02
Before
We come back with a recommendation
Within one working day: whether HAL is the right procedure, the right anaesthetic, an indicative price. If banding or a formal haemorrhoidectomy fits better, we say so.
- 03
Before
We arrange the appointment
Usually within one to two weeks. Any blood-thinning medication is reviewed with the team and you are told exactly how to prepare.
- 04
On the day
Arrival at the clinic
Arrival, consent and a chat with the coloproctologist and anaesthetist. Local plus sedation, spinal or GA — whichever was chosen.
- 05
On the day
The procedure itself
30 to 45 minutes in a proper theatre. Doppler-guided suture ligation of each feeding artery, with a mucopexy (RAR) added if there is prolapse.
- 06
On the day
Home the same day
A short recovery, written aftercare, and home within a few hours. With sedation, spinal or GA you will need someone to collect you.
- 07
After
Recovery and review
A dull ache and urgency for a few days, back to office work in three to seven days. A review is arranged if needed.
Typical end-to-end: 1–2 weeks from enquiry to procedure. Back to a desk job: 3–7 days.
When it helps
When HAL is the right step — and when it is not.
The situations we see most, plus the red flag that means a colonoscopy first, not a haemorrhoid procedure.
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Grade II–III haemorrhoids
Persistent bleeding or prolapse from internal haemorrhoids that reduce on their own or need a finger back.
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Failed banding or recurrence
Symptoms that keep coming back after rubber band ligation, or a prolapse component banding cannot fix.
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Bleeding refractory to conservative
Fibre, hydration, sitz baths and topical treatment tried properly for weeks — and the bleeding continues.
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Prolapse without external skin tags
Prolapsing cushions that need pushing back, without a large external component or thrombosis.
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Preference for less pain than MMH
A patient who has been offered a Milligan–Morgan and wants a less painful, quicker-recovery option first.
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On anticoagulation, carefully
Patients on blood thinners where a suture-based technique is preferred — coordinated with the anaesthetic team.
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Not for Grade IV or thrombosed piles
Large permanently prolapsed haemorrhoids, a big external component or acute thrombosis usually need a formal haemorrhoidectomy instead.
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Red flag: change in bowel habit
New rectal bleeding with weight loss, a change in bowel habit or a family history of bowel cancer needs a colonoscopy first, not HAL.
Procedure options
HAL is one option — here are the others.
What each option on the table actually involves — and which fits which problem.
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HAL under LA and sedation
Local anaesthetic block plus light sedation. Comfortable, quick, and home the same day — the option most adults choose.
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HAL under spinal
A spinal anaesthetic numbs from the waist down. Awake but pain-free, with a smooth recovery and no GA.
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HAL under GA
Asleep in a proper theatre with an anaesthetist. Preferred for anxious patients or longer combined procedures.
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HAL with mucopexy (RAR)
The dearterialisation is combined with a rectoanal repair — plicating the prolapsing tissue back to the anorectal ring.
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THD (Milligan proprietary)
Transanal haemorrhoidal dearterialisation — the branded THD device version of the same Doppler-guided technique.
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Skin tag excision at same visit
A residual external skin tag can be trimmed at the same anaesthetic if it bothers you cosmetically or with hygiene.
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Rubber band ligation instead
For Grade I–II bleeding without significant prolapse, banding in clinic is quicker, cheaper and often enough on its own.
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Coloproctology consultation only
An honest discussion of whether surgery is needed at all, and which option fits — no obligation.
Our vetted UK network
A small panel of coloproctologists, we picked them.
Consultant colorectal surgeons across London and the wider UK. Not listed publicly — introductions are made privately, once we understand your case.
Selection criteria
How we choose every coloproctologist in our network.
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Consultant colorectal surgeons, not trainees or general surgeons
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Sedation, spinal and GA available to suit the patient
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Banding, HAL, laser and Milligan–Morgan all offered so the recommendation is honest
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Follow the ACPGBI and NICE IPG525 guidance on patient selection
Safety and recovery
What to expect afterwards — honestly.
HAL is a well-established day-case procedure. The things worth planning are your anaesthetic choice, the stool-softener plan, and knowing what is normal after.
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Local, sedation, spinal or GA
Choice matters. Most patients have LA with sedation; spinal or GA is worth it if a mucopexy is being added or you would rather not be aware.
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A dull ache for three to seven days
Not the sharp pain of a formal haemorrhoidectomy, but a deep ache and urgency for a few days is normal, controlled with paracetamol and NSAIDs.
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Transient urgency and tenesmus
A feeling of needing to open the bowels comes and goes for one to two weeks as the sutures settle. It passes on its own.
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Stool softeners are important
Lactulose or similar for a fortnight prevents straining, which is the commonest cause of early bleeding or a stitch giving way.
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Minor bleeding is universal
A little fresh blood on the paper for one to two weeks is expected. Heavy bleeding is uncommon and the team is prepared for it.
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Back to office work in a few days
Most patients return to a desk job in three to seven days — much faster than the three to four weeks after a Milligan–Morgan.
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Recurrence is the honest trade-off
HAL has lower pain but a higher recurrence than a formal haemorrhoidectomy — 15 to 30% at three to five years. A repeat HAL, banding or MMH is possible.
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Urinary retention can happen
Five to ten per cent of patients cannot pass urine on the same day, especially after spinal anaesthesia. A short catheter is usually enough.
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Red flags
Heavy fresh bleeding, a fever, spreading pain or difficulty passing urine after 24 hours are not normal — call the clinic or A&E the same day.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the coloproctologist sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly — we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Indication and technique chosen
Why the procedure was done — grade of haemorrhoids, prolapse component, bleeding — and whether HAL was combined with a mucopexy.
- 02 Technique
Anaesthetic, ligation and mucopexy
Whether it was done under LA and sedation, spinal or GA, how many arterial branches were ligated, and what suture was used.
- 03 Findings
Prolapse, skin tags and incidental
Notes on the prolapse reduction, any external skin tags addressed, and any incidental findings such as a fissure or polyp.
- 04 Impression
Recovery, bowel plan and review
Read this first: expected recovery, the stool-softener and fibre plan, when to return to work and exercise, and whether a follow-up is needed.
Recognised by major UK insurers
Cover for haemorrhoidal artery ligation varies by insurer — usually funded when medically indicated after conservative treatment. We confirm cover before booking.
Frequently asked
Everything we get asked about HAL.
Quick answers on pain, cost, how it compares to banding and a Milligan–Morgan, and how much time off you actually need.
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What is haemorrhoidal artery ligation (HAL)?
HAL is a Doppler-guided procedure that uses a small ultrasound probe inside a proctoscope to find the six or so arteries feeding your internal haemorrhoids. Each artery is tied off with a dissolvable suture, cutting the blood supply so the haemorrhoids shrink. If there is prolapse, a rectoanal repair (RAR/mucopexy) is added to lift the tissue back into place. It is covered by NICE guidance IPG525 and endorsed by the Association of Coloproctology of Great Britain and Ireland.
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How is HAL different from banding?
Rubber band ligation is a quick clinic procedure that works well for Grade I–II bleeding. HAL is done in theatre and is more effective when there is a prolapse component or when banding has failed. Banding costs less; HAL treats more of the problem at once.
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How is HAL different from a Milligan–Morgan haemorrhoidectomy?
A Milligan–Morgan (MMH) cuts the haemorrhoids away. It is more painful, needs three to four weeks off work, but is the most durable. HAL leaves the cushions in place, is much less painful, and gets you back to work in a week — but has a higher recurrence at three to five years. The HubBLe trial confirmed MMH is more durable for Grade III haemorrhoids; HAL is a reasonable first step for many patients.
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What about stapled haemorrhoidopexy (PPH)?
PPH has fallen out of favour in the UK because of rare but serious complications — chronic pain, rectovaginal fistula. Most UK coloproctologists now prefer HAL or a formal haemorrhoidectomy over PPH.
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Does HAL hurt?
During the procedure you feel nothing — the area is fully numb, sedated, spinal or GA. Afterwards there is a dull ache and a feeling of urgency for three to seven days, controlled with simple painkillers. It is much less painful than a Milligan–Morgan.
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How much does a private HAL cost in the UK?
Roughly £2,200–£3,200 under LA and sedation, £2,600–£3,600 under spinal, and £2,800–£4,000 under GA. Adding a rectoanal repair for prolapse takes it to £2,800–£4,200. We confirm a firm figure within one working day.
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How long does HAL last?
About 70 to 85% of patients have good symptom control at one year. Recurrence runs at 15 to 30% at three to five years — higher than a formal haemorrhoidectomy but with far less pain. If symptoms come back, a repeat HAL, banding or a Milligan–Morgan is possible.
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When should I see a GP or A&E urgently?
New rectal bleeding with weight loss, a change in bowel habit or a family history of bowel cancer needs a colonoscopy before any haemorrhoid procedure. After surgery, heavy fresh bleeding, a fever, spreading pain or inability to pass urine after 24 hours are all reasons to seek same-day medical help.
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