Rubber Band Ligation of Symptomatic Internal Hemorrhoids: Results of 500 Cases

Komborozos, V; Skrekas, G; Pissiotis, Christos A.

doi:10.1159/000018803

Cited by 72 publications

(52 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These results are comparable to 66% to 82% cure rate reported by others (9,12,16,17) The most significant difference found between these two groups was postoperative pain. During the first postoperative week the differences in pain reported were statistically significant between the two groups.…”

Section: Discussionsupporting

confidence: 89%

“…Now it is the procedure of choice for patients who did not respond to office-based procedures or who unable to tolerate these procedures, grade three or four hemorrhoids, or patients with substantial external skin tags (5). Rubber band ligation is also widely used because it is a safe and effective method, involves less postoperative pain, and causes a quick recovery (9,(11)(12)(13). Complications are mostly minor.…”

Section: Discussionmentioning

confidence: 99%

“…However, there have been reports of severe sepsis following interventions for hemorrhoids (14). It is a safe method for treatment of symptomatic hemorrhoids in HIV positive patients and one with cirrhosis and portal hypertension (12,15).…”

Section: Discussionmentioning

confidence: 99%

“…There are a few studies available analyzing the effectiveness of RBL as an initial treatment for grade four symptomatic internal hemorrhoids (6,11,12). This study was designed to evaluate the success of staging RBL in treatment of grade four hemorrhoids, analyzing its complication and finally comparing the result with conventional hemorrhoidectomy.…”

Section: Objectivementioning

confidence: 99%

See 3 more Smart Citations

Comparative Study of Staging Rubber Band Ligation (RBL) and Hemorrhoidectomy in Treatment of Forth Degree Hemorrhoids

Mahmoud¹,

Hadavi²,

Vahedian³

et al. 2013

Ann Colorectal Res

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Objectivementioning

confidence: 99%

See 2 more Smart Citations

Comparative Study of Staging Rubber Band Ligation (RBL) and Hemorrhoidectomy in Treatment of Forth Degree Hemorrhoids

Mahmoud¹,

Hadavi²,

Vahedian³

et al. 2013

Ann Colorectal Res

View full text Add to dashboard Cite

“…5 There are substantial data in the literature concerning the efficacy and safety of RBL, including multiple comparisons with other interventions. [6][7][8][9][10][11][12] Recurrence varies from 11% to > 50%. This broad range probably reflects the definition of recurrence (patient symptoms or clinical appearance), the grade of haemorrhoids treated (grade I, no prolapse; grade II, spontaneously reducible prolapse; grade III, prolapse requiring manual reduction; and grade IV, unreducible prolapse), the number of treatments and/or the intensity and length of follow-up.…”

Section: Introductionmentioning

confidence: 99%

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

Brown

Tiernan

Biggs

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundOptimal surgical intervention for low-grade haemorrhoids is unknown. Rubber band ligation (RBL) is probably the most common intervention. Haemorrhoidal artery ligation (HAL) is a novel alternative that may be more efficacious.ObjectiveThe comparison of HAL with RBL for the treatment of grade II/III haemorrhoids.DesignA multicentre, parallel-group randomised controlled trial.PerspectiveUK NHS and Personal Social Services.Setting17 NHS Trusts.ParticipantsPatients aged ≥ 18 years presenting with grade II/III (second- and third-degree) haemorrhoids, including those who have undergone previous RBL.InterventionsHAL with Doppler probe compared with RBL.OutcomesPrimary outcome – recurrence at 1 year post procedure; secondary outcomes – recurrence at 6 weeks; haemorrhoid severity score; European Quality of Life-5 Dimensions, 5-level version (EQ-5D-5L); Vaizey incontinence score; pain assessment; complications; and cost-effectiveness.ResultsA total of 370 participants entered the trial. At 1 year post procedure, 30% of the HAL group had evidence of recurrence compared with 49% after RBL [adjusted odds ratio (OR) = 2.23, 95% confidence interval (CI) 1.42 to 3.51;p = 0.0005]. The main reason for the difference was the number of extra procedures required to achieve improvement/cure. If a single HAL is compared with multiple RBLs then only 37.5% recurred in the RBL arm (adjusted OR 1.35, 95% CI 0.85 to 2.15;p = 0.20). Persistence of significant symptoms at 6 weeks was lower in both arms than at 1 year (9% HAL and 29% RBL), suggesting significant deterioration in both groups over the year. Symptom score, EQ-5D-5L and Vaizey score improved in both groups compared with baseline, but there was no difference between interventions. Pain was less severe and of shorter duration in the RBL group; most of the HAL group who had pain had mild to moderate pain, resolving by 3 weeks. Complications were low frequency and not significantly different between groups. It appeared that HAL was not cost-effective compared with RBL. In the base-case analysis, the difference in mean total costs was £1027 higher for HAL. Quality-adjusted life-years (QALYs) were higher for HAL; however, the difference was very small (0.01) resulting in an incremental cost-effectiveness ratio of £104,427 per additional QALY.ConclusionsAt 1 year, although HAL resulted in fewer recurrences, recurrence was similar to repeat RBL. Symptom scores, complications, EQ-5D-5L and continence score were no different, and patients had more pain in the early postoperative period after HAL. HAL is more expensive and unlikely to be cost-effective in terms of incremental cost per QALY.LimitationsBlinding of participants and site staff was not possible.Future workThe incidence of recurrence may continue to increase with time. Further follow-up would add to the evidence regarding long-term clinical effectiveness and cost-effectiveness. The polysymptomatic nature of haemorrhoidal disease requires a validated scoring system, and the data from this trial will allow further assessment of validity of such a system. These data add to the literature regarding treatment of grade II/III haemorrhoids. The results dovetail with results from the eTHoS study [Watson AJM, Hudson J, Wood J, Kilonzo M, Brown SR, McDonald A,et al.Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial.Lancet2016, in press.] comparing stapled haemorrhoidectomy with excisional haemorrhoidectomy. Combined results will allow expansion of analysis, allowing surgeons to tailor their treatment options to individual patients.Trial registrationCurrent Controlled Trials ISRCTN41394716.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 88. See the NIHR Journals Library website for further project information.

show abstract