Infrared coagulation versus rubber band ligation in early stage hemorrhoids

Abstract

The ideal therapy for early stages of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but their efficacy is also lower. Thus, comfort or efficacy is a major concern. In the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. One hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (N = 54) or infrared coagulation (N = 46). Parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. The mean age was 38 years (range 19-68 years). The mean duration of disease was 17.5 months (range 12 to 34 months). The number of male patients was double that of females. Postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). Post-defecation pain was more intense with band ligation and so was rectal tenesmus (P = 0.0059). The patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, P = 0.03), but also had a higher recurrence or failure rate (P = 0.03). Thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. As infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.

The non-surgical management for hemorrhoidal disease. A systematic review

“…Dimitroulopoulos in a RCT reported 48.7% of postoperative pain; in Gupta's RCT 100% of patient complained pain (32,34). In contrast, Ahmad reported only 16% of pain rates (35).…”

“…In contrast, Ahmad reported only 16% of pain rates (35). Post-operative bleeding ranged from 44% in Dimitroulopoulos' to 15% in Gupta's RCTs (32,34). We evaluated the effectiveness in bleeding and prolapses control for different degrees of hemorrhoids; results are shown in Table 5.…”

“…Two RCTs reported 13% of recurrence rates for bleeding in I-II degrees in a mean follow-up period of three months (32,34). Recurrences after IRC treatment are shown in Table 7.…”

The Clinical Efficacy of Infrared Photocoagulation Versus Closed Hemorrhoidectomy in Treatment of Hemorrhoid

“…In a 5-year follow-up study on patients who had undergone IRC, 18 since this method is quick, safe, effective and painless for treatment of hemorrhoids, the conventional method can be changed to this method as an alternative method. In a study by Gupta 19 comparing IRC and rubber band ligation, it was shown that IRC is preferred to ligation in regard to lower postoperative pain as well as more suitable in case of recurrence. Charúa Guindic et al 20 introduced IRC technique as an excellent treatment method for hemorrhoids grades I and II with considerable low postoperative pain, low cost, and high success rate, with its failure rate estimated to be only 6.6%.…”

Rubber Band Ligation for Hemorrhoids: an Office Experience

“…Furthermore, pain and anal discomfort were reported to be greater when multiple bandings were performed. Gupta [23] found that out of 44 patients that underwent RBL, seven patients (15.9 %) reported pain. Ayman et al [4] found pain in 31 patients (4.13 %) out of the 750 studied group.…”