ABSTRACT

Recto Anal Repair (RAR) is a new, minimally-invasive treatment option for high-grade hemorrhoids which combines HAL (Hemorrhoidal Artery Ligation) and “lifting” of the hemorrhoidal prolapse, known as a mucopexy, in one procedure. Our prospective study evaluates both the early and long-term clinical outcomes of this procedure. 83 patients (43% female, 57% male, mean age 56 years (range 20-83)) with high-grade hemorrhoids (90% grade III, 10% grade IV) were treated using the RAR technique (equipment: A.M.I. GmbH, Austria) by the same surgeon in two different hospitals. Follow-up was carried out at 1 week, and then at 1, 3, 6 and 12 months, whereby clinically relevant parameters such as hemorrhoidal symptoms and re-prolapse were recorded and the spatial distribution of treated arteries analysed. Results: The number of patients showing relief of hemorrhoidal symptoms at 12-month follow-up was high. Bleeding was resolved in 89% of the patients, itching in 95%, burning in 100% and soiling in 100%. The recurrence of prolapse at 12 months was low, with no re-prolapse being recorded in 89% of the patients. Patient satisfaction was consistently high (>90%) at all follow-up intervals and the complication rate was low. In addition, data indicated that course of the branches of the superior rectal artery (SRA) into the corpus cavernosum recti (CCR) is unpredictable and varies considerably from patient to patient. Recto Anal Repair not only has several perioperative advantages – minimallyinvasive surgery, low pain levels and no major complications – but also offers prolonged relief for all hemorrhoidal symptoms and for reprolapse. RAR is an effective form of treatment for high-grade hemorrhoids.