DOI: http://dx.doi.org/10.18203/2349-3933.ijam20195243

Rubber band ligation of hemorrhoids: a hospital based study

Irfan Nazir Mir, Tajamul Rashid, Malik Suhail, Irshad Ahmad Kumar

Abstract


Background: Hemorrhoids are symptomatic anal cushions containing arteriovenous anastomosis. Patient with haemorrhoids can present as bleeding per rectum, something (mass) coming out per rectum, perianal itching, Anaemia due to occult blood loss. Various modalities of treatment have been developed to treat symptomatic haemorrhoids. This study was undertaken to determine the efficacy of rubber band ligation in the management of haemorrhoids.

Methods: This study was a prospective study conducted in the Department of Surgery, Government Medical College, Srinagar from June 2015 to June 2018. Patients at any age with first, second- or third-degree internal haemorrhoids were included in the study. Patients with fourth degree, complicated haemorrhoids, previous anorectal surgery or anorectal pathology, and chronic liver disease were excluded. A total of 212 patients were included in the study. Rubber band ligation was done as an OPD procedure. The patients were followed at 2 weeks, 4 weeks, 3-month, 6 month and 1 year after the procedure.

Results: In this study, out of 212 patients, 154(72.6%) were males and 58(27.4%) females. The mean age of this study was 38.7 yr. (Range 17-73 yr.). Patients presented with the complaints of bleeding (184, 86.8%), prolapse (114, 53.7%), constipation (116, 54.7%), priuritis ani (36, 17.0%), pain (12, 5.6%). Band ligation was successful in 188(88.8%) patients, 169(79.7%) patients were cured and in 19(8.9%) improvement was obtained. Various complications occurred after band ligation including vasovagal syncope (2, 0.9%), bleeding per anum (6, 2.8%), pain (12, 5.6%), fissure in ano (1, 0.5%). Recurrence after one year was seen in 9(4.2%) patients.

Conclusions: Author concluded in this study that RBL is an effective outpatient treatment for grade II and III internal haemorrhoids without much complications.


Keywords


Bleeding per anum, Dentate line, Haemorrhoids, Outpatient department, Pruritis ani, Rubber band ligation

Full Text:

PDF

References


Burkitt HG, Quick CRG, Reed JB. Anal and perianal disorders. In: Essential Surgery-Problems, Diagnosis and Management. 4th edition, Hunter L, Hewat C, Swan R eds, Churchill Livingstone Elsevier: China, 2007.

Banov Jr L, Knoepp Jr LF, Erdman LH, Alia RT. Management of hemorrhoidal disease. J South Carolina Med Associat. 1985;81(7):398.

Hosking SW, Johnson AG, Smart HL, Triger DR. Anorectal varices, haemorrhoids, and portal hypertension. Lancet. 1989;333(8634):349-52.

Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, et al. The prevalence of hemorrhoids in adults. Intern J colorectal dis. 2012;27(2):215-20.

Vassilios A, Komborozos VA, Skrekas GJ, Pissiotis CA. Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases. Dig Surg. 2000; 17: 71-76

Pezzullo A, Palladino E. Rubber band ligation of hemorrhoids. 5-year follow-up. Il Giornale di chirurgia. 2000;21(5):253-6.

Longman RJ, Thomson WH. A prospective study of outcome from rubber band ligation of piles. Colorect Dis. 2006;8(2):145-8.

Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation: an epidemiologic study. Gastroenterol. 1990;98(2):380-6.

Murie JA, MacKenzie I, Sim AJ. Comparison of rubber band ligation and haemorrhoidectomy for second‐and third‐degree haemorrhoids: A prospective clinical trial. British J Surg. 1980;67(11):786-8.

Bat L, Melzer E, Koler M, Dreznick Z, Shemesh E. Complications of rubber band ligation of symptomatic internal hemorrhoids. Dis colon and rectum. 1993;36(3):287-90.

Gupta PJ, PravinJ G. Radio frequency coagulation versus rubber band ligation in early hemorrhoids: pain versus gain. Medicina. 2004;40(3):232-7.

Wrobleski DE, Corman ML, Veidenheimer MC, Coller JA. Long-term evaluation of rubber ring ligation in hemorrhoidal disease. Diseases of the Colon and Rectum. 1980;23(7):478.

Bayer I, Myslovaty B, Picovsky BM. Rubber band ligation of hemorrhoids: convenient and economic treatment. J clini gastroenterol. 1996;23(1):50-2.

Wechter DG, Luna GK. An unusual complication of rubber band ligation of hemorrhoids. Diseases of the colon and rectum. 1987;30(2):137-40.