Background: Haemorrhoidal disease is one of the most common anorectal disorders encountered in surgical practice. Conventional haemorrhoidectomy is effective but often associated with postoperative pain, bleeding, delayed recovery, and patient discomfort. Hemorrhoidal Artery Ligation (HAL) is a minimally invasive procedure that reduces arterial inflow to haemorrhoidal cushions. The present study evaluates a modified HAL technique combined with spiral ligation of the haemorrhoidal mass, aimed at achieving simultaneous dearterialization, plication, and mucopexy. Aim: To evaluate the efficacy and safety of Hemorrhoidal Artery Ligation with Spiral Ligation in Grade II and Grade III internal haemorrhoids. Materials and Methods: A prospective pilot study was conducted on 15 patients diagnosed with Grade II and Grade III internal haemorrhoids. All patients underwent HAL combined with spiral ligation of the haemorrhoidal mass. Patients were evaluated for bleeding, prolapse, postoperative pain, complications, recurrence, and patient satisfaction during a follow-up period of 3 months. Results: Out of 15 patients, 8 (53.33%) had Grade II and 7 (46.67%) had Grade III internal haemorrhoids. Significant reduction in bleeding and prolapse was observed in all patients. Complete symptomatic relief was achieved in 13 patients (86.67%), while 2 patients (13.33%) reported occasional mild discomfort. No major complications or recurrence were observed during follow-up. Conclusion: HAL with Spiral Ligation appears to be a safe, effective, minimally invasive, and sphincter-preserving technique for Grade II and Grade III internal haemorrhoids. The procedure demonstrated excellent symptomatic relief, minimal postoperative pain, and early recovery.
Bali* et al. (2026) studied this question.