Haemorrhoidal artery ligation compared to alternative surgical techniques for the treatment of grade II-IV haemorrhoids: A systematic review

Background. Haemorrhoidal disease is a common disorder in the Western World that commonly requires surgical treatment, but original open techniques were associated with significant complications and pain. Haemorrhoidal Arterial Ligation (HAL) has gained popularity for relatively low complication and postoperative pain rates. This review assesses clinical outcomes of this technique in comparison to alternative modern techniques. Methods. The literature was searched on MEDLINE, EMBASE, Google Scholar, and Cochrane Library databases. Search terms: dearterialization, artery ligation, mucopexy, recto-anal repair. Inclusion criteria: RCTs, original publications, grade II, III and/or grade IV haemorrhoids, elective procedures. Exclusion criteria: non-English, non-adults, published pre-2016. Results. 14 RCTs were included in the systematic review. HAL performed poorly in terms of recurrence, with a pooled recurrence rate of 10.34% for grade III haemorrhoids. HAL had a similar recurrence rate to Procedure for Prolapse and Haemorrhoids. Pain was comparable between groups. Conclusion. HAL is a safe surgical technique for the treatment of grade II to grade IV haemorrhoids. It still has a relatively low complication rate, and pain scores are comparable to other non-invasive techniques, and superior to open techniques. HAL still performs poorly in terms of recurrence rates. New modified procedures including suture-mucopexy only and tissue-selecting techniques appear to have better therapeutic potential.