Outcome of Haemorrhoidal Artery Ligation and Recto Anal Repair (HAL-RAR) with Doppler Guidance for Symptomatic Grade-II, III and IV Internal Haemorrhoids

Abstract

Background: Internal haemorrhoids are very common all around the world and the classical surgical treatment is open haemorrhoidectomy for a long time. This procedure has a lot of complications and is very painful for the patient. Doppler guided HAL-RAR has shown satisfactory results in the literature with minimal pain and a significantly lower rate of complications compared to open haemorrhoidectomy . Objective: To assess the outcome of a relatively new surgical procedure (HAL-RAR) using doppler guidance for the treatment of grade-II, III and IV internal haemorrhoids. Methods: This case series was conducted at Surgimed hospital, Lahore, Pakistan, between May 2015 to December 2021. One hundred patients who attended the outpatient department of the hospital were recruited for this study. These patients presented with grade-II, III or IV symptomatic internal haemorrhoids. Surgical intervention in the form of HAL-RAR was performed in all patients and outcome was measured in terms of mean operating time, length of hospital stays, post-operative pain, recurrence of prolapse and bleeding, and early and late post-operative complications with one year follow up for all patients. Results: Out of these 100 patients, 72 were males and 28 were females. On average, seven haemorrhoidal artery ligations and three recto anal repairs were performed in each patient. The average hospital stay was 31 hours with a range between 24 hours to 72 hours. Early post-operative pain was minimum and only twelve patients required narcotic analgesics. Three patients complained of excessive pain lasting for five days. Seven patients had self-limiting bleeding, two patients had post-operative bleeding which was controlled by re-ligation of the bleeding point and one patient developed a perianal fistula. In the long term follow up, one patient had recurrence of prolapse six months after the surgery. Conclusion: HAL-RAR with doppler was a safe and efficient method for treatment of grade-II, III and IV internal haemorrhoids, with very low post-operative pain scores, satisfactory relief of symptoms, and low recurrence rates.