The Treatment of Second Degree Haemorrhoids by Injection, Rubber Band Ligation, Maximal Anal Dilatation, and Haemorrhoidectomy: A Prospective Clinical Trial

Abstract

One hundred and twenty patients with confirmed second degree haemorrhoids were randomly allocated to four treatment groups: injection, rubber band ligation, maximal anal dilatation, and haemorrhoidectomy. Each group consisted of 30 patients. All patients were regularly followed up for at least one year. Assessment at one year showed that haemorrhoidectomy “cured” the haemorrhoids in 29 out of 30 patients. Rubber band ligation relieved 25 out of 30 and maximal anal dilatation 24 out of 30. Injection was the least effective treatment, and relieved 18 of the 30 patients, with a cure rate of 60% only. Haemorrhoidectomy caused pain in all cases, anal stenosis in two, postoperative haemorrhage in two, and the patients required an average hospital stay of 11.5 days and an average of a further 15.5 days off work. Rubber band ligation was painless in 26 patients out of 30, and maximal anal dilatation was painless in 25 out of 30. There were no postoperative complications in the latter two treatment groups. Haemorrhoidectomy is good in “curing” the disease, but the higher possibility of postoperative pain and complications and longer hospital stay would not justify its use in the treatment of second degree haemorrhoids. Both rubber band ligation and maximal anal dilatation are effective and relatively free from complications. Rubber band ligation has the additional advantage of not requiring hospital stay or anaesthesia and is therefore considered to be the most appropriate method of treatment for second degree haemorrhoids.

Comparative Study of Hemorrhoidectomy and Rubber Band Ligation in Treatment of Second and Third Degree Hemorrhoids in Kashmir

“…These findings correlate well with those of Murie et al [14] and Bayer et al [28]. However, Cheng et al [26] reported that 96 % patients were cured at 1 year following hemorrhoidectomy compared with 83 % following RBL. Almost similar findings were observed by Steinberg [19] and MacRae and Mcleod [29].…”

“…Cheng et al [26] report that hemorrhoidectomy is good in curing the disease, but higher possibility of post-op pain, complications and longer hospital study would not justify its use in the treatment of second hemorrhoid. Lewis et al [27] are of view that RBL is cheaper alternative to hemorrhoidectomy and reduces the demand for beds and pressure on surgical waiting list.…”

A Comparative Study of Different Treatment Modalities of Haemorrhoids

“…Anal stenosis is a rare long term complication due to excess loss of anal mucosa with particular procedure and subsequent healing causes different grades of anal stenosis. Cheng FC et al [11] found haemorrhoidectomy caused pain in all cases, anal stenosis in 2 out of 30 patients. But no patient in band ligation and sclerotherapy had similar complaints.…”

“…Rubber band ligation was painless in 5 patients and produced pain for more than 48hours in 15 patients. Cheng FC et al [11] found that, haemorrhoidectomy caused pain in all cases, band ligation was painless in 26 out of 30 patients. Shah et al [12] revealed significantly higher (p<0.001) proportion of patients with pain who underwent band ligation than whom underwent injection Sclerotherapy.…”

Recent trends in management of haemorrhoids

“…This is in accordance with the observations made by Gagloo et al 8 Cheng et al reported that haemorrhoidectomy is very effective in curing haemorrhoids, but higher possibility of postoperative operative complications, longer hospital study and development of new surgical procedures reduced its use in the treatment of hemorrhoids. 12 Buchmann et al and Mortensan et al are of view that Lord's dilatation procedure is cheaper with reduced postoperative complications and demand for beds in hospital. 13,14 But some complications like fecal incontinence may be seen.…”