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

Aim: The study aimed to evaluate and compare the short and long-term outcomes of doppler-guided (DG) hemorrhoidal artery ligation and rectoanal repair (HAL-RAR) using a wireless-doppler guided probe (HALO ™ Trilogy) and stapled hemorrhoidopexy (SH) for treatment of II-III hemorrhoids. Methods: This cohort study included patients who underwent HAL-RAR (n = 89) or SH (n = 174) for grade II-III hemorrhoids between January 2020 and December 2021. After propensity score matching at a 1:1 ratio, 76 patients for each group were analyzed. Short and long-term outcomes were collected. Pain was measured using a Visual Analogue Scale (VAS) at POD1, POD 10, 1 month, and 6 months after surgery. The enrolled patients completed the Hemorrhoidal Disease Symptom Score Quality of Life (HDSS/SHS QoL) Quality of Life QoL questionnaire preoperatively and during a regular follow-up visit at 24 months after surgery. Results: Groups exhibited comparable overall postoperative complication rates (15.7% HAL-RAR/ 17.1% SH; p = 0.3843). Postoperative pain via VAS showed median scores of 4, 3, 1, 1 for HAL-RAR and 6, 4, 2, 1 for SH at POD1, POD10, 1-month, and 6-months, respectively. At a median follow-up of 12 months, the recurrence rate was 10.5% in the HAL-RAR group and 9.2% in the SH group (p = 0.778801), respectively. At 24 months, 15.7% of HAL-RAR patients and 19.7% of SH patients remained symptomatic (p = 0.22313). Median post-op QoL index was 1 (HAL-RAR) and 0.92 (SH), p = 0.0365. Conclusions: HAL-RAR is a safe and feasible technique in treating grade II-III hemorrhoids showing better outcomes in terms of postoperative pain and QoL. Significance: This paper adds a new perspective in comparing the HAL-RAR and SH, focusing the attention on the patients and not surgical tecniques. A long and difficult follow-up was completed to fully understand the long-term results and the impact on the QoL of the patients that underwent these procedures.