Abstract
Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.
Highlights
Hemorrhoidal pathology is one of the most common causes of gastroenterology consultation
Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids
The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3
Summary
Hemorrhoidal pathology is one of the most common causes of gastroenterology consultation. It is a benign condition that is expressed by intermittent functional manifestations. Internal hemorrhoids manifest themselves by rectorrhagia and/or prolapse, more rarely by thrombosis. The treatment of internal hemorrhoids involves many medical, instrumental and surgical methods, the choice of which must be adapted to each patient according to the stage and symptoms expressed. Instrumental treatment, of which there are several methods, currently occupies an important place in the management of hemorrhoidal disease. The aim of the instrumental treatment is not to restore a normal anatomy, but to permanently omit the symptoms by creating a cicatricial fibrosis which fixes the mucosa in the deep plane and reduces the vascularization, allowing the symptomatic relief (rectorragies) and the correction of a possible anatomical defect (prolapse). Elastic ligation is considered an efficient technique widely used in the world
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