Prospective Randomized Trial Comparing HAL-RAR Versus Excisional Hemorrhoidectomy: Postoperative Pain, Clinical Outcomes, and Quality of Life

Abstract

Purpose. To compare outcomes of hemorrhoid artery ligation with recto-anal repair (HAL-RAR) and excisional hemorrhoidectomy (EH). The primary objective was to compare postoperative pain, and the secondary objectives were the following: symptom resolution rates, postoperative morbidity, recurrence, and changes in quality of life. Method. Prospective randomized controlled trial, including 40 patients with grades III-IV hemorrhoids who were allocated 1:1 to HAL-RAR and EH. Follow-up evaluation was performed at 15 days, 30 days, 6 months, 12 months, and then annually. Pain was measured using a Visual Analogic Scale and was self-recorded by patients. Quality of life was measured with Short Form Survey-36 questionnaire. Results. Postoperative pain was lower in the HAL-RAR group during the first 30 postoperative days. Moreover, from day 7 onward more patients in the HAL-RAR group reported complete absence of pain (Visual Analogic Scale score = 0). Globally, symptom resolution was significantly higher (P = .03) in the HAL-RAR group at day 15. Bleeding resolution was observed earlier in the HAL-RAR group than in the EH group (P = .04), but no differences in the resolution of prolapse, itching, and soiling were observed during the 30-day follow-up. After a mean follow-up of 15 months (range 12-27 months), no differences in postoperative morbidity and no recurrences were observed. An improvement was observed in all sections evaluated by the Short Form Survey-36 questionnaire with both techniques. Conclusion. HAL-RAR provokes less postoperative pain during a shorter period than EH and achieves resolution of hemorrhoidal symptoms with less postoperative complaints. No differences in morbidity and recurrence rate were observed after 12 months of follow-up.

Four-Week Pain Profile and Patient Non-Adherence to Pharmacological Pain Therapy After Day Surgery

“…Ceulemans et al concluded that patients undergoing hemorrhoid surgery still suffer from moderate postoperative pain in the first postoperative week, despite multimodal analgesic treatment ( 22 ). Carvajal Lopez et al even report moderate postoperative pain up till POD9 after hemorrhoid surgery ( 23 ), confirming the need for a longer follow-up period after ambulant surgery. A promising new tool to optimize the follow-up of patients undergoing ambulant surgery was e-health, defined as the use of information and communication technology for health.…”

Long-term results and quality of life after stapled hemorrhoidopexy vs Doppler-guided HAL-RAR: a propensity score matching analysis

“…[1] The pain may be due to excessive tissue resection and aggressive mucosal management which can irritate the perianal nerves. [11] Conversely, the non-excisional surgical procedures have the advantage over excisional techniques of less associated local trauma, rapid recovery, and less intense postoperative pain but seem to be associated with higher recurrence rates. [1,12] In our series, a signi cant decrease in pain was observed in patients undergoing HAL-RAR with TRILOGY during the rst 30 days after surgery.…”

Milligan–Morgan hemorrhoidectomy vs. hemorrhoid artery ligation and recto-anal repair: a comparative study

“…Aligned with the results of the present study but with relatively different symptom adjusted patient grouping, Scheyer et al reported that HAL–RAR provided prolonged relief for patients with HD whose main symptoms are bleeding, pruritus and pain but not for patients with prolapse as the initial indication [ 25 ]. In addition, Lopez et al in their prospective randomized trial comparing HAL–RAR with excisional hemorrhoidectomy reported that bleeding resolution was observed earlier in patients submitted to HAL–RAR than in patients submitted to excisional hemorrhoidectomy [ 26 ].…”