Long-term impact of haemorrhoidal artery ligation on anal function and continence.
A, A., S, A., M, N., C, R., S, C., & A, A. (2026). Long-term impact of haemorrhoidal artery ligation on anal function and continence.. Irish medical journal.
A A, S A, M N, C R, S C, A A. Long-term impact of haemorrhoidal artery ligation on anal function and continence.. Irish medical journal. 2026; PMID: 42348182
A A, S A, M N, et al. Long-term impact of haemorrhoidal artery ligation on anal function and continence.[J]. Irish medical journal. 2026.
@article{a2026,
author = {Anwar A and Abushara S and Naseem M and Rampersad C and Casey S and Arif A},
title = {Long-term impact of haemorrhoidal artery ligation on anal function and continence.},
journal = {Irish medical journal},
year = {2026},
note = {PMID: 42348182},
}
TY - JOUR AU - Anwar A AU - Abushara S AU - Naseem M AU - Rampersad C AU - Casey S AU - Arif A TI - Long-term impact of haemorrhoidal artery ligation on anal function and continence. T2 - Irish medical journal PY - 2026 AN - PMID:42348182 ER -
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.