Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center

Background Rectoanal repair (RAR), which combines doppler-guided hemorrhoidal artery ligation (HAL) and mucopexy via lifting of the hemorrhoidal prolapse, offers a minimally invasive alternative to conventional hemorrhoidectomy. Methods Patients with grade II hemorrhoids were treated with HAL, and patients with grade III and IV hemorrhoids were treated with the RAR procedure by two surgeons. Postoperative follow-up was performed clinically and by proctoscopy after 8 weeks routinely, and long-term follow-up was performed using a standardized postal questionnaire. Results The overall complication rate was 29 % ( n = 118). After short-term follow-up, 26 % ( n = 106) of patients reported recurrent or persistent prolapsing piles, while 21 % ( n = 86) of patients had recurrent bleeding. After long-term follow-up, 24 % ( n = 98) of patients reported prolapsing piles, 3 % ( n = 12) bleeding, 3 % ( n = 12) pruritus, and 2 % ( n = 8) anal pain, while 20 % ( n = 82) complained of persistent mixed symptoms. Conclusions HAL and RAR provide prolonged relief for patients with hemorrhoidal disease whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as an initial indication.