Skip to main content

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



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.


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.


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.


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.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Johanson JF, Sonnenberg A (1990) The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology 98:380

    CAS  PubMed  Google Scholar 

  2. Guy RJ, Seow-Choen F (2003) Septic complications after treatment of haemorrhoids. Br J Surg 90:147–156

    Article  CAS  PubMed  Google Scholar 

  3. Rowsell M, Bello M, Hemingway DM (2000) Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial. Lancet 355:779–781

    Article  CAS  PubMed  Google Scholar 

  4. Mehigan BJ, Monson JR, Hartley JE (2000) Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial. Lancet 355:782–785

    Article  CAS  PubMed  Google Scholar 

  5. Pernice LM, Bartalucci B, Bencini L et al (2001) Early and late (ten years) experience with circular stapler haemorrhoidectomy. Dis Colon Rectum 44:836–841

    Article  CAS  PubMed  Google Scholar 

  6. Riss S, Riss P, Schuster M, Riss T (2008) Impact of stapled haemorrhoidopexy on stool continence and anorectal function—long-term follow-up of 242 patients. Langenbecks Arch Surg 393:501–505

    Article  PubMed  Google Scholar 

  7. Herold A, Kirsch J, Staude G, Hager T, Raulf F, Michel J (2000) A German multicentre study on circular stapled haemorrhoidectomy. Colorectal Dis 2:18

    Article  Google Scholar 

  8. Morinaga K, Hasuda K, Ikeda T (1995) A novel therapy for internal hemorrhoids: ligation of the hemorrhoidal artery with a newly devised instrument (Moricorn) in conjunction with a doppler flow meter. Am J Gastroenterol 90:610–613

    CAS  PubMed  Google Scholar 

  9. Sohn N, Aronoff JS, Cohen FS, Weinstein MA (2001) Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg 182:515–519

    Article  CAS  PubMed  Google Scholar 

  10. Arnold S, Antonietti E, Rollinger G, Scheyer M (2002) Doppler ultrasound assisted haemorrhoid artery ligation. A new therapy in symptomatic hemorrhoids. Chirurg 73:269–273

    Article  CAS  PubMed  Google Scholar 

  11. Shelygin IUA, Titov AIU, Veselov VV, Kanametov MKH (2003) Results of ligature of distal branches of the upper rectal artery in chronic hemorrhoid with the assistance of Doppler ultrasonography. Khirurgiia (Mosk) 1:39–44

    Google Scholar 

  12. Greenberg R, Karin E, Avital S, Skornick Y, Werbin N (2006) First 100 cases with Doppler-guided hemorrhoidal artery ligation. Dis Colon Rectum 49:485–489

    Article  PubMed  Google Scholar 

  13. Hardy A, Chan CLH, Cohen CRG (2005) The surgical management of haemorrhoids—a review. Dig Surg 22:26–33

    Article  CAS  PubMed  Google Scholar 

  14. Bursics A, Morvay K, Kupcsulik P, Flautner L (2004) Comparison of early and 1-year follow-up results of conventional hemorrhoidectomy and hemorrhoid artery ligation: a randomised study. Int J Colorectal Dis 19:176–180

    Article  PubMed  Google Scholar 

  15. Theodoropoulos GE, Sevrisarianos N, Papaconstantinou J et al (2008) Doppler-guided hemorrhoidal artery ligation (DGHAL), rectoanal repair (RAR), sutured hemorrhoidopexy (SHP) and minimal mucocutaneous excision (MMCE) for grade III-IV hemorrhoids: a multicenter prospective study of safety and efficacy. Colorectal Dis 12:125–134

    Article  Google Scholar 

  16. Zagryadskiy EA, Gorelv SI (2008) Transanal Doppler-guided hemorrhoidal artery ligation/recto anal repair (HAL-RAR) for treatment of Grade 3-4 hemorrhoids: a new mini-invasive technology. Pelviperineology 27:151–155

    Google Scholar 

  17. Scheyer M, Antonietti E, Rollinger G, Mall H, Arnold S (2006) Doppler-guided hemorrhoidal artery ligation. Am J Surg 191:89–93

    Article  PubMed  Google Scholar 

  18. Satzinger U, Feil W, Glaser K (2009) Recto anal repair (RAR): a viable treatment option for high-grade hemorrhoids. One year results of a prospective study. Pelviperineology 28:37–42

    Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to H. Pokorny.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Scheyer, M., Antonietti, E., Rollinger, G. et al. Hemorrhoidal artery ligation (HAL) and rectoanal repair (RAR): retrospective analysis of 408 patients in a single center. Tech Coloproctol 19, 5–9 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: