Rubber band ligation of three primary hemorrhoids in a single session

Abstract

Rubber band ligation was used in 221 patients with first or second-degree hemorrhoids. All three primary hemorrhoids were ligated at a single out-patient session without anesthesia. Nineteen patients were lost to follow up. For the 202 patients under review, the follow up period ranged from three to 39 months with a mean of 18.4 months and median of 17 months. Excellent or good results were obtained in 183 patients (90.6 per cent). Moderate to severe pain was noticed by 58 patients (28.7 per cent). Further banding was required in 28 patients (13.9 per cent) and hemorrhoidectomy in six patients (3 per cent). The overall complication rate resulting from the treatment procedure was 3.5 per cent.

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

“…Anal pain is the most common complication after RBL. Mild pain is experienced by at least 25-50% of patients for the first 48 hours after banding, 15,[70][71][72][73][74] which is also consistent with our results. The pain may be reduced by the concomitant use of local anaesthetic.…”

“…5 The incidence of bleeding after RBL is 1-2.8%. 3,77 Significant bleeding requiring admission or intervention is more difficult to analyse, but pooling of the data available suggests an incidence of 0.7%, 3,11,[14][15][16][17][18] Bleeding is more common if patients are taking anti-platelet agents, non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulants. 3 These patients were excluded in our trial.…”

“…Urinary retention has been described after both HAL and RBL, with a reported incidence of 0.7% after HAL 5 and about 0.3% after RBL. 3,11,14,15,17,18,83 Urinary retention is dependent on the severity of disease and degree of surgery, the analgesia requirement and pre-existing bladder outlet compromise. [85][86][87] In addition, day case treatment may reduce the incidence.…”

“…Pain is common for a few hours following RBL and occasionally patients experience pain so severe as to require admission to hospital (around 1% 3 ), bleeding (3-4%, sometimes necessitating further treatment 9 ) and vasovagal symptoms (3% 13 ). There have also been rare incidences of blood transfusion 3,11,[14][15][16][17][18] and severe pelvic sepsis, with a few instances leading to death. 13 Recurrences can be treated by re-banding or by surgical intervention.…”

Harmonic scalpel versus conventional haemorrhoidectomy for grade III and IV haemorrhoids: a randomized controlled trial

“…This male preponderance is also consistent with the studies available in literature. [5][6][7] While evaluating the clinical presentation and specifically looking at symptoms all patients (100%) in the present study had bleeding per rectum. This presentation is quite consistent with literature showing a range from 77.5% -100%.…”