title: HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up.
abstract: OBJECTIVE
  To analyse prospectively results of HAL-RAR technique by evaluating pain, perioperative complications and clinical outcome after two years followup.
  
  
  METHODS
  A prospective study design including 30 consecutive patients with haemorrhoids grade III-IV treated from June 2012. After discharge, patients received a specific questionnaire to record postoperative pain, delayed complications, evolution/disappearance of the symptoms that led to the surgical intervention (bleeding, prolapse, itching, pain and soiling). A visual analog scale (VAS) was used to measure pain. Outpatient follow-up was carried out at 7 days, and 1, 6 and 12 months and annually thereafter. Pre, intra and postoperative data (including physical examination) had been recorded prospectively.
  
  
  RESULTS
  The median operating time (range) was 40 (26-60) minutes. Average hospital stay (range) was 11 (3-25) hours. No postoperative complications were observed in 29 cases (96.6%). Median follow-up was 26 (12-36) months. All the patients attended the follow-up. Mean postoperative pain was VAS = 1.7 on the seventh day and it was practically non-existent (VAS = 0.7) 1 month after the procedure. 87.5% of patients confirmed complete relief of symptoms after 30 days and 93% of patients feel free of symptoms 6 months after the procedure. No patient has experienced late complications as dyschezia, urgency, soiling or faecal incontinence. After 24 months follow-up, recurrence of bleeding and prolapse was observed in only 1 patient; 93% of patients have considered results of HAL-RAR as very good or excellent.
  
  
  CONCLUSIONS
  HAL-RAR is safe and almost painless technique and it has very good results in the control of haemorrhoidal symptoms. This procedure should be considered as an effective first treatment option for haemorrhoids.
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain. Electronic address: carloshoyuela@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Hoyuela
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Carvajal
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Juvany
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Daniel
authors.initials: D
authors.lastname: Troyano
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Miquel
authors.initials: M
authors.lastname: Trias
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Martrat
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Ardid
authors.affiliation: Dept. of General and Digestive Surgery, Hospital Platón Barcelona, Universitat Autònoma Barcelona, c/ Platón 21, 08006 Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Obiols
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D061865:Hemorrhoidectomy / Q000009:adverse effects / Q000379:methods*; D006484:Hemorrhoids / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D010149:Postoperative Pain; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D013536:Suture Techniques; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods; D018084:Ultrasonography, Interventional / Q000379:methods; D014656:Vascular Surgical Procedures
keywords: HAL-RAR; Haemorrhoidal artery ligation; Haemorrhoids; Minimally invasive surgery; Recto anal repair; Treatment