A Preliminary Study on Hemorrhoid Artery Ligation with Recto-anal Repair (HAL-RAR) without Doppler Guidance for Grade III Internal Hemorrhoids

Background: Many techniques have been announced for managing internal hemorrhoids. Hemorrhoid artery ligation with recto-anal repair (HAL-RAR) is a safe and almost painless technique that successfully controls hemorrhoidal symptoms. This procedure should be considered an effective first treatment option for hemorrhoids. The most common problem that should be discussed is the cost of this procedure, especially in developing countries. Here, we report the safety and effectiveness of HAL-RAR without Doppler guidance in treating stage III internal hemorrhoids in a single-center teaching hospital in Indonesia. Methods: As a modification from the standard Doppler-guided HAL-RAR procedure, we evaluated the clinical outcomes of HAL-RAR without Doppler guidance on grade III internal hemorrhoids. All patients with no previous hemorrhoid surgery were included in this study; cases associated with proctitis and colorectal cancer were excluded. Results: A total of 61 patients with grade III internal hemorrhoids were managed via the modified HAL-RAR technique. The patients accepted this technique well; pain control was achieved early on the first postoperative day. The average pain score (visual analog scale) before being discharged was 1.8, and the average postoperative length of stay was 1.4 days, with no postoperative bleeding found during the follow-up period. Conclusion: We found HAL-RAR without Doppler guidance to be safe and effective, resulting in minimal pain and a short hospital stay. This modification reduces the expenses and could be a reasonable option in managing patients with symptomatic internal hemorrhoids.