DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20192535

Hemorrhoidectomy versus rubber band ligation in treatment of second and third degree hemorrhoids: a comparative study

Nimesh B. Thakkar

Abstract


Background: Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used Out patient treatment.

Methods: We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. The diagnosis of hemorrhoids is primarily based on the proctoscopic  examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1 year from January 2017 to December 2017. It includes 50 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of Tertiary Care Hospital in Gujarat. These 50 patients were selected randomly and divided into two groups of 25 patients each (hemorrhoidectomy group and RBL group). Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed.

Results: Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery.

Conclusions: RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.


Keywords


Daycare surgery, Haemorrhoids, Hemorrhoidal artery ligation, Minimal invasive management, Open surgery, Painless, Rubber band ligation

Full Text:

PDF

References


Thomson WH. The nature of hemorrhoids. BJS 1975;62:542-52.

American society of colon and rectal surgeons. Practice parameters for the treatment of haemorrhoids. Dis Colon Rectum. 1993;36:1118-20.

Lord PH. A day case procedure for the cure of third degree hemorrhoids. Br J Surg. 1969;56:747-9.

Iyer VS, Shrier I, Gordon PH. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum. 2004;364-70.

Ferguson JA, Mazier WP, Ganchrow MI, Friend WG. The closed technique of hemorrhoidectomy. Surgery. 1971;70:480.

Infantino A, Altomare DF, Bottini C, Bonanno M, Mancini S. Prospective randomized multicentre study comparing stapler haemorrhoidopexy with Doppler-guided transanal haemorrhoid dearterialization for third-degree haemorrhoids. Colorectal Dis. 2012;14:205-11.

Pucher PH, Qurashi M, Howell AM, Faiz O, Ziprin P, Darzi A, et al. Development and validation of a symptom-based severity score for haemorrhoidal disease: the Sodergren score. Colorectal Dis. 2015;17:612-18.

Murie JA, Mackenzie I, Sim AJ. Comparison of rubber band ligation and hemorrhoidectomy for second and third degree haemorrhoids: a prospective clinical trial. BJS. 1980;67(11):786-8.

Steinberg DA, Liegois HJ, Willaims A. Long term review of the results of rubber band ligation of haemorrhoids. BJS. 1975;62:144-6.

Cheng FC, Shum DW, Ong GB. The treatment of second degree haemorrhoids by injection, rubber band ligation, maximalanal dilatation and haemorrhoidectomy: a prospective clinical trial. Aust NZ J Surg. 1981;51(5):458-62.

Konings M, Debets JM, Baeten CG. Rubber band ligation of hemorrhoids: symptoms almost gone after 6 weeks but many patients need retreatment in the long run. Ned Tijdschr Geneeskd. 1999;143(24):1265-8.

Hosch SB, Knoefel WT, Pichlmeier U, Schulze V, Busch C, Gawad KA, et al. Surgical treatment of piles. Diseases of the colon & rectum. 1998 Feb 1;41(2):159-64.

Sohn N, Aronoff JS, Cohen FS, Weinstein MA. Transanal hemorrhoidal dearterialization is an alternative to operative hemorrhoidectomy. Am J Surg. 2001 Nov 1;182(5):515-9.