Haemorrhoids: haemorrhoidal artery ligation

Haemorrhoids are cushions of submucosal vascular tissue located in the anal canal starting just proximal to the dentate line. Haemorrhoidal disease occurs when there are symptoms such as bleeding, prolapse, pain, thrombosis, mucus discharge, and pruritus. Incidence is difficult to ascertain as many people with the condition will never consult a medical practitioner. One study reported a prevalence of 39%, with nearly half of those identified reporting haemorrhoidal symptoms. First- and second-degree haemorrhoids are classically treated with some form of non-surgical ablative/fixative intervention. Third-degree are treated with rubber band ligation or haemorrhoidectomy and fourth-degree with haemorrhoidectomy. Eventual choice of treatment will be based on a number of individual and operative factors. In previous versions of this overview we evaluated the evidence for a broad range of interventions for haemorrhoids, including closed haemorrhoidectomy, infrared coagulation/photocoagulation, injection sclerotherapy, open excisional (Milligan-Morgan) haemorrhoidectomy, radiofrequency ablation, rubber band ligation, and stapled haemorrhoidectomy. Haemorrhoidal artery ligation (HAL; also known as transanal haemorrhoidal de-arterialisation) has grown in popularity since the last overview. For this update we have, therefore, focused on the evidence for the effectiveness of HAL and how it compares to other selected surgical and non-surgical interventions for haemorrhoids. We evaluated evidence from RCTs and systematic reviews of RCTs. We found insufficient evidence to judge the effectiveness of haemorrhoidal artery ligation compared with injection sclerotherapy , infrared coagulation , rubber band ligation , or radiofrequency ablation . For haemorrhoidal artery ligation compared with stapled haemorrhoidectomy , closed haemorrhoidectomy , and open excisional (Milligan-Morgan) haemorrhoidectomy , the RCT evidence showed that there was a balance between the benefits (e.g., symptom and quality of life improvement, shortened length of hospital stay) and harms (e.g., postoperative pain, overall complications) associated with each procedure.