Related Experiment Video
Updated: Jun 26, 2026

Acupoint Needle-Embedding Combined with Ironing Therapy for Postoperative Pain After Anal Surgery
Published on: June 23, 2023
Long-term impact of haemorrhoidal artery ligation on anal function and continence
Aims:
Haemorrhoidal artery ligation (HALO) and variants including Doppler-guided HAL (DG-HAL), HAL with rectoanal repair (HAL-RAR), and transanal haemorrhoidal dearterialisation (THD) serve as minimally invasive alternatives to excisional haemorrhoidectomy, reducing pain while preserving sphincter function. Long-term faecal incontinence remains a concern due to its quality-of-life impact. This systematic review assessed prevalence, severity, and patterns of incontinence beyond six months post-procedure across HAL techniques.
Methods:
PRISMA 2020 guidelines directed searches of PROSPERO, MEDLINE, PubMed, Scopus, Cochrane Library, and ScienceDirect for 2015-2024 studies reporting continence >6 months after HAL-based procedures. Six studies (3 RCTs, 1 prospective, 2 retrospective cohorts; total n=671 patients) met PICOS criteria, with Wexner Incontinence Scores reported or retrospectively mapped. Quality appraisal used CASP Cohort Checklist.
Results:
Seventeen (2.5%) of 671 patients developed postoperative faecal incontinence. Of these, 14 (82%) cases were mild (Wexner 1-4) and transient, resolving within 3-6 months; 3 (18%) were moderate (Wexner 5-8), primarily in HAL-RAR (9/158 [5.7%]). Standard HAL showed 0/76 (0%) cases; THD had 1/104 (1.0%); DG-HAL had 7/293 (2.4%). No severe incontinence occurred.
Discussion:
HALO techniques demonstrate excellent long-term continence safety (overall 2.5% low-grade incontinence). HAL-RAR's higher risk (5.7%) warrants counselling. Standardised scoring and multicentre trials are recommended.
Related Concept Videos
Assessment of the Rectum and Anus
Rectal Inspection
Begin by inspecting the perianal and anal areas for color, texture, rashes,...
Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
Varicose Veins II: Diagnostic Studies and Interprofessional Care
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...

