Hemorrhoidal Ligation Research Articles

Rubber band ligation of hemorrhoids: relapse as a function of time.

Rubber band ligation is a well established treatment of internal second-degree hemorrhoids. Up to now, the long-term results (> 5 years) of this method have not been assessed. The aim of this study was to determine the long-term success rate of rubber band ligation in patients with a first episode of second-degree hemorrhoids not responding to medical treatment (local cream with laxative). A total of 92 patients who were treated between 1979 and 1997 for second-degree hemorrhoids responded to a questionnaire. The need for complementary conservative (sclerotherapy, cryotherapy or rubber band ligation) or surgical treatment was considered indicative of relapse. The collected data were analyzed according to the Kaplan-Meier method. The average follow-up time was 5.6 years. There were 21 patients who suffered a relapse. The probability of successful treatment was 0.77 (range: 0.67-0.88) after 5 years and 0.68 (range: 0.5-0.86) after 10.6 years. We conclude that rubber band ligation represent an efficient long-term treatment for second-degree hemorrhoids. Approximately two thirds of the patients are cured after 5 years and more than a half after 10 years.

Endoscopic hemorrhoidal ligation: preliminary clinical experience

Background: Endoscopic hemorrhoidal ligation may provide an alternative to surgical treatment of internal hemorrhoids. This study assessed the safety and efficacy of endoscopic elastic band ligation for bleeding internal hemorrhoids. Methods: Endoscopic hemorrhoid ligation was performed in 20 adult patients who had chronic rectal bleeding attributed to internal hemorrhoids. Elastic band ligation was accomplished using a ligating device attached to the end of a video endoscope. Repeat endoscopy was done 3 weeks after the initial procedure. Results: Seventy band ligations were performed during 23 separate sessions. Post-therapy endoscopy showed reduction of hemorrhoidal size by at least one grade in 19 of 20 patients (95%). Bleeding resolved in 19 of 20 patients (95%) in 5.4 months (mean) of follow-up; 18 of 20 (90%) required only one banding session. No major complications (perforation, secondary bleeding, deep ulceration) occurred in this small group. Conclusions: Preliminary data indicates that endoscopic hemorrhoidal ligation is a safe and effective technique for treating internal hemorrhoids. It holds promise as an important technique for successfully treating and possibly eradicating symptomatic internal hemorrhoids. (Gastrointest Endosc 1998;48:49-52.)

Development and status of proctology in Japan.

Formerly in Japan, the treatment of anal diseases was performed with techniques transmitted from Asian countries such as China and Korea using herbs, necrotizing agents, ligation, seton, and other methods. Before World War II, western medicine and techniques were brought in from Germany, including Whitehead's operation. After the war, new knowledge was introduced from the United Kingdom and the United States: ligation and excision for hemorrhoids, sphincter-preserving methods such as Hanley's and Parks' for fistulas, and sliding skin graft methods such as Carmels' for anal fissure. After their introduction, those methods were revised and improved in Japan. Unfortunately, however, the results of those improvements were not introduced to other countries in medical journals or in presentations at international conferences. At this time, I am honored to give an overview of proctology in Japan for this special Japanese issue.

Multiple versus Single Rubber Band Ligation for Internal Hemorrhoids: A Review of 450 Consecutive Cases

In the last 10 years we have treated 450 consecutive patients symptomatically affected by 1st- or 2nd-degree hemorrhoids with rubber band ligation. The patients were divided into 2 groups: group A, 216 patients treated from 1983 to 1989, and group B, 234 patients treated from 1990 to 1993. In group A multiple ligations (2 or 3) were made in a single session. In the group B one ligation at a time was performed. In group A satisfactory results were obtained in 78% of the cases, whereas in group B the results were good in 91% of patients (p < 0.01). Complications also decreased: bleeding decreased from 25 to 5% and pain from 22 to 9% (p < 0.01). Sepsis was present in 30% of the group-A cases, but was never seen in group B. In conclusion rubber band ligation offers better results if it is made with one ligation at a time, repeating the operation every 4 weeks.

Rubber band ligation of hemorrhoids. Convenient and economic treatment.

We have reviewed and summarized 12 years of experience in treating hemorrhoids, a condition that affects 4.4% of the Western population, of whom a third are symptomatic and need treatment. During this time, in a proctological outpatient clinic of an urban hospital, 2,934 patients with second- and third-degree hemorrhoids were treated by rubber band ligation (RBL), usually one ligation per session. Of these patients, 79% were completely cured, 18% needed one or more additional sessions of treatment, and 2.1% failed to be cured by RBL and were referred for conventional hemorrhoidectomy. We found that by using this safe and convenient treatment we can save hundreds of hospitalization days and thousands of sick-leave days per year.

内視鏡的内痔核結紮術の治療成績

内視鏡的内痔核結紮術の治療成績

New device for rubber band ligation of hemorrhoids.

We describe a new accessory for rubber band ligation of hemorrhoids. By using the new instrument it is possible to abscind the elastic band applied to the base of the hemorrhoidal node without entailing traumatic interventions. Of a total of 62 elastic ligatures, this device was used in the last 18 procedures, and provided excellent results. This instrument enables the surgeon to carry out the technique in a more accurate way and, if necessary, rectify "dangerous mistakes" that can occur while accomplishing the procedure itself.

内視鏡的内痔核結紮術

We develop a new technique for the prolapse and bleeding internal hemorrhoids (Goligher III) such as fiberscopic hemorrhoidal ligation (FHL) . The technique of FHL is as follows. An upper GI tract fiberscope is employed and the scope is retroflexed in the rectum and the hemorrhoids are ligated using Stiegmann-Goff ligator. A one week, 2-3 ml of 1% aethoxysklerol (AS) is injected between every hemorrhoids submucosally. We performed FHL in total of 15 cases and excellent results (complete disappearance of chief complaints) were obtained in 15 cases (100%) . We consider that this new technique allows better visualization and less pain compare to conventional treatment and assumed to be useful in non-oprative hemorrhoidal therapy.

Single-operator hemorrhoid ligator.

A new device for elastic band ligation of hemorrhoids is presented. The three instruments used for this procedure, the anoscope, clamp, and ligator, are combined to allow performance of the procedure by a single operator.

Complications of rubber band ligation of symptomatic internal hemorrhoids

In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.

A Comparative Study of Different Treatments of Hemorrhoids

Hemorrhoid is a common anal problem in our country that is currently treated by many different methods. Three modalities were assessed in a randomized prospective trial in which 848 patients with a second-degree hemorrhoid were treated by rubber band ligation (470 patients), injection sclerotherapy (280 patients), or cryosurgery (98 patients). The effectiveness of each method was assessed clinically at 3, 6, 9, and 12 months after initial treatment, and determined by improvement in presenting symptoms. All patients complained of rectal bleeding and prolapse of the hemorrhoid on defecation, but only 69% had anal pain and 14% suffered from pruritus ani. Rubber band ligation was found to be superior to the other methods, and displayed statistical significance when compared to injection sclerotherapy and cryosurgery.

Hemorrhoidal ligation. A review of efficacy.

Two hundred forty-one patients undergoing hemorrhoidal rubber band ligation over a five-year period were reviewed to focus on complications. Three patients (1.2 percent) were hospitalized. Two, on oral anticoagulants, recovered from bleeding complications. One patient developed a band-related abscess that resolved with drainage. Twenty patients (8.3 percent) reported pain associated with the procedure. Three patients went on to subsequent surgical hemorrhoidectomy. There were no deaths in the series. This report agrees with previously published series highlighting the efficacy and cost containment of hemorrhoidal ligation. Continued reliance on this approach to hemorrhoidal disease is justified.

Endogenous Endophthalmitis With Lenticular Abscess Caused by Enterobacter Agglomerans (Erwinia Species)

We report for the first time a case of metastatic endophthalmitis caused by the gram-negative organism Enterobacter agglomerans (Erwinia species). One day following internal hemorrhoidal ligation, the patient developed anterior uveitis that progressed to panophthalmitis with a lenticular abscess and a necrotic retina. Despite aggressive surgery and appropriate antibiotic therapy, the affected eye lost useful vision.

Combined ligation-injection treatment of hemorrhoids.

A method of combined band ligation and sclerosant injection of internal hemorrhoids is described.

A new concept of the anatomy of the anal sphincter mechanism and the physiology of defecation: Treatment of hemorrhoids: Report of a technique

A technique for the treatment of hemorrhoids has been presented. It is based on a recent study in which the persistence of the anorectal band, a remnant of the anorectal sinus, and failure of rectal neck remodeling are considered responsible for the initiation of the hemorrhoid disease. The constricting effect of the anorectal band on the rectal neck results in elevation of its pressure, straining at defecation, and prolapse of the rectal mucosa. There were 502 patients with third and fourth degree hemorrhoids. The preoperative rectal neck pressure was high in all of them. The technique comprises division of the anorectal band and hemorrhoid ligation. The results were satisfactory, and the complications were negligible. The rectal neck pressure was normalized and straining disappeared. The procedure is simple and easy. Compared with the other techniques for hemorrhoid treatment, it offers the advantage of dealing with the primary etiologic factor.

Rational approach to treatment of hemorrhoids based on a theory of etiology.

In a series of 600 patients suffering from hemorrhoidal symptoms, 709 treatment procedures were performed. Only 7% of the patients required hemorrhoidectomy. In the remaining patients, symptoms were relieved by conservative therapy comprising sclerotherapy, band ligation, or cryotherapy of the internal hemorrhoids only. On the basis of this series, the following proposals are made: (1) the concept of hemorrhoidal destruction should be replaced by one of fibrosis, (2) only the internal hemorrhoids need be treated, (3) hemorrhoids need not be treated unless they produce symptoms and then only the symptoms need be treated, (4) only those far-advanced hemorrhoids in which there has been extensive fragmentation of the supportive connective tissue need be treated surgically, and (5) treatment may be chosen according to the stage of the hemorrhoids.

An improved technique of rubber band ligation of hemorrhoids

Based on the new concept that a hemorrhoid is caused by downward displacement of the anal cushion, rubber band ligation is applied on the redundant rectal mucosa above the hemorrhoid to prevent prolapse. The Hinkel-James anoscope is an ideal instrument for this purpose. It gives excellent exposure of the rectal mucosa and prevents the anal cushion from incorporating into the banding.

In defense of cryotherapy for hemorrhoids. A modified method.

The rationale of nonoperative hemorrhoid treatment, whether injection, ligation, or cryotherapy, consists of correction of prolapse and bleeding by the creation of submucosal fibrosis. Cryotherapy of hemorrhoids is most effective and has the least side effects when directed at the internal hemorrhoids only, at a high level, and in stages, each application being for a period of one minute only. A plan of treatment selection is presented, based on the stage of the hemorrhoids. The results of 528 treatment procedures are reported.

Elastic Band Ligation of Internal Hemorrhoids

Elastic Band Ligation of Internal Hemorrhoids

Rubber band ligation of hemorrhoids.

While rubber band ligation has found increasing acceptance as a method of dealing with internal hemorrhoids, there is a paucity of literature on the subject. This report gives a detailed, step-by-step approach to this technique.