Tehran University of Medical Sciences (TUMS) Academic Journal of Surgery 2423-3218 8 1 2025 04 25 1 5 Mehdi Dehghani Firoozabadi Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran Aidin Yaghoubi Notash Yaghoubi Notash Department of General Surgery, Shariati Hospital, Tehran University of Medical Sciences, Iran Ali Dah Mardeh Ei Division of Colorectal and Cancer Surgery, General Surgery Department, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran Amirhossein Shahsavand Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran 2025 04 25 Background: Hemorrhoidal Artery Ligation and Recto-Anal Repair (HAL-RAR) is a minimally invasive procedure designed to treat grades III and IV hemorrhoidal disease by addressing both vascular supply and tissue prolapse. Methods: This study retrospectively evaluated patients undergoing HAL-RAR between January 2024 and January 2025. Data collected included demographics, disease severity, postoperative pain (Days 1 and 3), hospital stay, and time to first non-problematic defecation. Results: A total of 16 patients were included. Postoperative pain was low, with 62.5% reporting no pain on Day 1 and 88% on Day 3. Median pain scores decreased over time and were not significantly affected by sex. Defecation function recovered rapidly, with 100% achieving non-problematic defecation within two days postoperatively. Age showed a non-significant trend toward delayed recovery and slightly increased pain. No major complications were observed, and all patients were discharged after one night. Conclusions: HAL-RAR appears to be a safe, well-tolerated, and effective short-term treatment for advanced hemorrhoidal disease, offering minimal pain and rapid functional recovery. However, larger studies with control groups and long-term follow-up are required to confirm these findings and evaluate durability. https://ajs.tums.ac.ir/index.php/ajs/article/view/312