What is the role of hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR) (HAL with mucopexy) in the treatment of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR) (HAL with mucopexy) are other minimally invasive alternatives to conventional hemorrhoidectomy that show promise for prolonged relief in patients with symptomatic hemorrhoidal disease. A retrospective single-center study of 408 patients with grade II hemorrhoids treated with HAL and grade III and IV hemorrhoids treated with RAR revealed an overall complication rate of 29% (118 patients). [55] Follow-up in the short term revealed recurrent/persistent prolapsing piles in 26% of patients, with recurrent bleeding in 21%; at long-term follow-up, 24% of patients reported prolapsing piles; 3% each, bleeding or pruritus; 2%, anal pain; and 20%, persistent mixed symptoms. [55]

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