Underwent Rubber Band Ligation Research Articles

Rubber Band Ligation (RBL) vs Standard Hemorrhoidectomy (SH) for Treatment of Haemorrhoids

Objective: To compare rubber band ligation (RBL) vs standard hemorrhoidectomy for the treatment of haemorrhoids.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Feb 2020 to Jan 2021.
 Methodology: A total of 200 patients with 2nd and 3rd-degree haemorrhoids who met the inclusion and exclusion criteria were included in the study. Group-A patients underwent rubber band ligation, while in Group-B, Milligan Morgan hemorrhoid-dectomy was done.
 Results: There were 200 patients (100 in each Group). There were 135 males (67.5%) and 65 females (32.5%). The female to male ratio was 1:2.01. Mean age was 44.73 ± 8.36 years in Group-A and 43.48 ± 8.98 years in Group-B. Mean duration of complaints was 8.72 ± 4.32 months in Group-A and 10.89 ± 3.80 in Group-B. Post-procedure patients were called for follow up in a third and eighth week. The most common complication seen in Group-A was recurrence which was 18% (p-value 0.001), and pain in Group-B, 82% (p-value 0.001), which was statistically significant.
 Conclusion: We concluded that Rubber band ligation is a quick, safe and cost-effective procedure for the outpatient department for Grade II and III haemorrhoids. The recurrence rate is high compared to standard hemorrhoid-dectomy, but its advantages make it a first-line procedure for Grade II and III haemorrhoids in the outpatient departments.

Clopidogrel bisulfate (Plavix) does not increase bleeding complications in patients undergoing rubber band ligation for symptomatic hemorrhoids

BackgroundThe incidence of postprocedural bleeding in patients undergoing rubber band ligation (RBL) for symptomatic internal hemorrhoids while taking clopidogrel bisulfate is unknown. To determine the postprocedural bleeding risk of RBL for patients taking clopidogrel compared with age- and sex-matched controls. Materials and methodsThis is a retrospective case-controlled cohort study analyzing data from 2005 to 2013 conducted at a single tertiary care academic center. The study included a total of 80 rubber bands placed on 41 patients taking clopidogrel bisulfate and 72 bands placed on 41 control patients not taking clopidogrel matched for age and sex. The 30-d rates of significant and insignificant bleeding events after RBL were recorded. A bleeding event was considered significant if the patient required admission to the hospital, transfusion of blood products, or additional procedures to stop the bleeding. Insignificant bleeding was defined as passage of blood or clots per rectum with spontaneous cessation and no need for additional intervention. ResultsThere was no significant difference in the number of bleeding events per band placed in the clopidogrel group when compared with the control group (3.75% versus 2.78%, P = 0.7387). The rate of significant (2.5% versus 1.39%, P = 0.6244) and insignificant bleeding events (1.25% versus 1.39%, P = 0.9399) was also similar between the two groups. Two significant bleeding events occurred in the clopidogrel group requiring intervention: cauterization in one patient and colonoscopy and transfusion in the other. ConclusionsThe risk of a bleeding complication after RBL for hemorrhoids does not appear to be increased in patients taking clopidogrel. Our results support the practice of continuing clopidogrel bisulfate in the periprocedural period as the associated risk of thrombosis is greater than the risk of bleeding.

Rubber band ligation of hemorrhoids

Haemorrhoids constitute a frequent clinical problem. A variety of conservative treatment options have been proposed, the majority of which can be safely performed on an outpatient basis, like the rubber band ligation RBL which is selected in this study . The aim of the study is to prove the possibility and benefit of the procedure as a treatment for the first In this study we review the management of 100 patient (70 male and 30 female) with different degree of hemorrhoids, and the age range from 20-75 year most of them at 30-50 year old, underwent rubber band ligation(RBL) on outpatient clinic(private clinic) during period of 19 month from December 2006 to jully2008. 90 patient(90%) did well and 10 patient(10%) did not feel better two of them (2%) did open hemorrhoidectomywhile8 patient(8%) kept on conservative measures. The RBL is reliable and safe outdoor procedure for the first, second and third degree hemorrhoids.

Evaluation of Office Ligation in the Treatment of Hemorrhoids at Nepalgunj Medical College Teaching Hospital

Introduction: Rubber band ligation, an outpatient procedure for treatment of 2nd and 3rd degree hemorrhoids is an effective mode of management.Aims and objectives: To evaluate the effectiveness of rubber band ligation as an office procedure in the treatment of 2nd and 3rd degree hemorrhoids.Material and Methods: This is a cross sectional hospital based study of 30 cases that underwent rubber band ligation as an outpatient procedure for 2nd and 3rd degree hemorrhoids done in Nepalgunj Medical College Teaching Hospital from the period of August 2014 to June 2015. The patients were followed up for six months for the development of procedure related complications, relief of symptoms, and requirement of any further interventions. The total cost of treatment was calculated and the time off work was noted. Patients were requested to assess the forms of treatment as excellent, moderately successful or of little help based on their results post treatment. Statistical analysis using SPSS software (version 20) was done and p value less than 0.05 was taken as significant.Results: Post procedure complications were milder and self-limiting, with discomfort in 57.5% (2nd degree) and 60% (3rd degree), pain in 5% (2nd degree) 40% (3rd degree), bleeding in 22.5% (2nd degree) and 30% (3rd degree) of patients with absence of any major complications (sepsis or death). Majority (77.5% in 2nd degree, 70% in 3rd degree) of the patients significantly improved after initial treatment with band ligation. Some of the patients treated by band ligation required further intervention i.e. 16.66% in 2nd and 16.66% in 3rd degree as repeat ligation in the immediate post-op period and were managed subsequently. But none of them required any surgical procedures. Majority of the patients treated by band ligation were able to resume their normal work within three day i.e. 95% in 2nd and 90% in 3rd degree hemorrhoids. Most of the patients spent Rs 2000- 2500 (52.5% in 2nd and 40% in 3rd degree) which most was on routine checkups and follow-ups but it was very cheaper as compared to others modalities. Most of the patients (77.5% in 2nd and 70% in 3rd degree) treated by band ligation assessed the treatment as excellent.Conclusion: Rubber band ligation is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an outpatient procedure with significant improvement in quality of life. Immediate relief of symptoms can be obtained in the post-operative period and therefore be considered as the treatment of choice for second and third degree hemorrhoid. Though the complications are slightly higher and improvement in symptoms were delayed than in second degree but still Rubber Band Ligation proved to be effective even in 3rd degree hemorrhoid.Journal of Nepalgunj Medical College Vol.13(1) 2015: 17-20

Rubber Band Ligation for Hemorrhoids: an Office Experience.

The objective of this study was to analyze the effectiveness, safety, quality of life, and the results of the treatment for second- and third-degree hemorrhoids using rubber band ligation (RBL). This is a retrospective study for 890 patients who came to outpatient clinic from August 2007 to March 2013; all underwent rubber band ligation using the Barron applicator on an outpatient basis for second- and third-degree internal symptomatic hemorrhoids. Data were collected from the patients' files. The patients were asked to return to outpatient clinic for follow-up at 2weeks and 1 and 6months and by telephone call every 6months for 2years. Six hundred seventy-seven patients (76%) were cured (P = 0.31). Symptomatic recurrence was detected in 178 cases (20%) after 2years. Thirty-five patients (4%) had some complications from RBL, which required no hospitalization. The complications were pain, rectal bleeding, and vasovagal symptoms (2.6, 1, and 0.4% of patients, respectively). Seven hundred fifty-six (85%) of the patients are males; the mean age was 45years (range, 16-86years). RBL is a simple, safe, and effective method for treating symptomatic second- and third-degree hemorrhoids as an outpatient procedure with significant improvement in quality of life.

Local anaesthetic infiltration for the rubber band ligation of early symptomatic haemorrhoids: a systematic review and meta-analysis.

The objective of this article is to systematically analyse the randomized, controlled trials evaluating the effectiveness of local anaesthetic infiltration prior to the rubber band ligation of early symptomatic haemorrhoids. Published randomized, controlled trials comparing the use of local anaesthetic (LA) versus no-local anaesthetic (NLA) for the rubber band ligation of early symptomatic haemorrhoids were analysed using RevMan®, and the combined outcomes were expressed as odds ratios (OR) and standardized mean difference (SMD). Four randomized, controlled trials evaluating 387 patients were retrieved from the standard electronic databases. The risk of treatment failure (OR 0.44; 95% CI 0.07, 2.79; z = 0.87; p = 0.39) and post-procedure complications (OR 0.48; 95% CI 0.08, 2.76; z = 0.83; p = 0.41) was similar between two techniques. However, the post-procedure pain score (SMD -5.19; 95% CI -9.08, -1.30; z = 2.62; p < 0.009) was significantly lower in the group of patients undergoing rubber band ligation of haemorrhoids under local anaesthetic injection. The use of LA appears to have clinically measurable advantages over NLA in the rubber band ligation of early symptomatic haemorrhoids to lessen post-procedure pain.

An Evaluation of the effectiveness of Barron Band Ligation as a Modality of Treatment of Hemorrhoids

Objective: The ob j e c t i v e of t he s t ud y is to e v al uat e t he effectiveness of rubber band ligation in the treatment of internal hemorrhoids. Methods: This is a prospective study of 120 cases who underwent rubber band ligation as an outpatient procedure for internal haemorrhoids. Binomial probability pre-post test were used for statistical analysis, pvalue less than 0.0001 was taken as significant. Results: One hundred twenty patients underwent rubber band ligation as a outpatient procedure for internal haemorrhoids. No major post procedure complications as sepsis, vasovagal reflex were observed. Only 36 patients had moderate discomfort following procedure, which lasted for 3-4 days and none had severe discomfort, and 84 patients did not need pain relief; 84 patients returned to work just after procedure .of symptom improvement post procedure compared to at presentation only 49% patients had bleeding post procedure out of 108 patients who had bleeding at presentation p-value of which was significant as pvalue = 0.00055, 6 patients had pain post procedure out of 36 patients who had pain at presentation p-value = 0.00024 was found significant. None patient after procedure had prolapse out of 24 patients who had prolapse on presentation (p-value = 0.0025). No patient had irritation or discharge post procedure (p-value = 0.00036). Ninety-six patients assessed rubber band ligation as excellent and 24 patients as of moderate help. Conclusion: Rubber band ligation for internal haemorrhoids is an effective modality of treatment mainly in 2° grade haemorrhoid which is convenient, simple, high patient acceptance with limitations as post procedure discomfort and pain.

A comparative study of rubber band ligation and flavonoids (Daflon) in the treatment of haemorrhoids

Background: Haemorrhoids is a common disease affecting people of all ages and both sexes. Though there is no confusion on the treatment of 3rd and 4th degree haemorrhoids, there is still confusion regarding the ideal treatment for 1st and 2nd degree haemorrhoids. Aims & Objective: To compare the safety, efficacy, advantages and disadvantages of Rubber Band Ligation and Micronized Flavonoids in the treatment of internal haemorrhoids. Material and Methods: Two hundred patients of haemorrhoids were treated, One hundred cases with Rubber Band Ligation and rest hundred with Daflon 500 mg. The outcome measured in term of relief from bleeding and duration of treatment. Results: 82% of patients on Daflon and 60% of patients undergoing Rubber Band Ligation were completely cured (P

Efficacy of rubber band ligation in third degree hemorrhoid

Introduction: Rubber band ligation (RBL) is an effective treatment in symptomatic 1st and 2nd degree hemorrhoids. The aim of this study was to assess the outcome, effectiveness and complications RBL as out patient procedure for symptomatic 3rd degree hemorrhoids.&#x0D; Method: Seventy one patients with symptomatic third degree hemorrhoids underwent rubber band ligation in the department of surgery at National Academy of Medical Sciences, Patan hospital and Shree Birendra Army hospital. Nine defaulters were excluded from the study and data on 62 patients were analysed. Outcome measures were symptomatic cure i.e. stoppage of bleeding and reduced mucosal prolapse. Complications were categorized as immediate (within 1 hour), early (within one week) and late (within 6 weeks).&#x0D; Result: There was symptomatic improvement (stoppage of bleeding and reduced mucosal prolapse) in 47 (75.8%) patients. Four patients required repeat banding. In 15 (24.2%) patients hemorrhoidectomy was performed due to failure of RBL. Pain and bleeding was common immediate and intermediate complication respectively.&#x0D; Conclusion: Rubber band ligation is an effective, outdoor procedure for symptomatic 3rd degree hemorrhoids with acceptable morbidity.

Results of 244 Consecutive Patients with Hemorrhoids Treated with Doppler-Guided Hemorrhoidal Artery Ligation

Aim: This study was designed to determine the effect of treating hemorrhoids with the Doppler-guided hemorrhoidal artery ligation (DG-HAL) procedure. Methods: From June 2005 to March 2008, 244 consecutive hemorrhoidal patients underwent hemorroidal artery ligation performed with the DG-HAL system from AMI®. All patients were evaluated postoperatively with a proctologic examination and interview. Further follow-up was performed by telephone with a standardized questionnaire. When indicated, patients revisited the clinic for further examination and treatment. Results: 244 patients were treated with DG-HAL. The mean follow-up time was 18.4 months (range 1.4–37.2). Sixty-seven percent of the patients had an improvement of symptoms after one treatment. Fifty-three patients (22%) underwent a second procedure because of persisting symptoms. Thirteen patients (25%) underwent a second DG-HAL and 40 (75%) underwent rubber band ligation. In total, 69% of the patients had a good response using the DG-HAL technique. Multivariate logistic regression analysis revealed prolapse to be an independent risk factor for persistent symptoms (OR = 2.38, 95% CI 1.10–5.15). Patients with grades 3 and 4 hemorrhoids had a higher risk of developing recurrent disease (OR = 4.94, 95% CI 0.67–36.42). Conclusion: DG-HAL seems to be an effective procedure for treating low-grade hemorrhoids. A resection procedure should be the treatment for patients with recurrent disease.

CR14 *ANAL INTERSPHINCTERIC NERVE BLOCK PRIOR TO RUBBER BAND LIGATION OF HAEMORRHOIDS. IS IT EFFECTIVE? A RANDOMISED CONTROL TRIAL

Purpose: Significant pain and discomfort are reported by a proportion of patients undergoing rubber band ligation of haemorrhoids. Several nerve blocks have been trialled with varied results. The aim of this study was to determine whether an anal intersphincteric nerve block may reduce post‐operative pain and analgesic requirements in these patients.Methodology: One hundred sequential patients undergoing rubber band ligation of haemorrhoids were randomised to either an anal intersphincteric nerve block using 0.5% Marcaine with adrenaline or to the control group. The procedures were performed by a single surgeon using the KilRoid (TM) rubber band ligator (Astratech – Sweden). Patients were assessed for pain and analgesic use in the immediate post operative period and at 24 hours. Both the patient and data collector were blinded to whether a nerve block had been administered.Results: There was no statistically significant difference between the two groups in median post operative pain (3.0 vs. 2.0 p &gt; 0.0.29), median post operative analgesic use (1.6 vs. 3.3 p = 0.62), median pain score at 24 hour (4.14 vs. 4.22 p = 0.9) and median analgesic use at 24 hours (1.0 vs. 1.0 p = 0.13).Conclusions: There is no benefit from performing an intersphincteric nerve block in patients undergoing rubber band ligation of haemorrhoids.

Long-Term Functional Outcomes After Laparoscopic and Open Rectopexy for the Treatment of Rectal Prolapse

Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there is little long-term follow-up and functional outcome data available. Patients who had abdominal surgery for prolapse during a ten-year period were identified and interviewed to ascertain details of prolapse recurrence, constipation, incontinence, cosmesis, and satisfaction. Additional details on recurrences that required surgery and mortality were obtained from chart review and the State Death Registry. Of 321 prolapse operations, laparoscopic rectopexy was performed in 126 patients, open rectopexy in 46, and resection rectopexy in 21 patients. At a median follow-up of five years after laparoscopic rectopexy, there were five (4 percent) confirmed full-thickness recurrences that required surgery. Actuarial recurrence rates of laparoscopic rectopexy were 6.9 percent at five years (95 percent confidence interval, 0.1-13.8 percent) and 10.8 percent at ten years (95 percent confidence interval, 0.9-20.1 percent). Seven patients underwent rubber band ligation for mucosal prolapse and seven required other surgical procedures. There was one recurrence after open rectopexy (2.4 percent) and one after resection rectopexy (4.7 percent), and there was no significant difference between groups. Overall constipation scores were not increased after laparoscopic rectopexy, with no significant difference to open rectopexy or resection rectopexy. This study has demonstrated that laparoscopic rectopexy has reliable long-term results for treating rectal prolapse, including low recurrence rates and no overall change in functional outcomes.

Ano-rectal physiological changes after rubber band ligation and closed haemorrhoidectomy.

The effect of treatment for haemorrhoids on ano-rectal physiology was studied in a prospective longitudinal follow-up study. Thirty-six consecutive patients having II-III degree (Group I, 18 patients) or IV degree (Group II, 18 patients) haemorrhoids were studied. Group I underwent rubber band ligation while Group II underwent closed scissors haemorrhoidectomy. Patients in Group I had significantly lower maximum basal pressure (P < 0.05) and also significantly lower maximum squeeze pressure (P < 0.05) compared to Group II before treatment. Both basal and squeeze pressures dropped after haemorrhoidectomy (P < 0.001) whereas they remained unchanged after rubber band ligation (P > 0.1). The volume of first sensation was higher in Group II before treatment (P < 0.001) and remained so after treatment. Rectal compliance was higher (P < 0.005) in Group I before treatment. It increased significantly in both groups (P < 0.05, Group I; P < 0.001, Group II) after treatment. The results show a significant increase in anal pressures in constantly prolapsing (IV degree) haemorrhoids. Most of the physiological differences observed between the two groups were abolished after treatment. This suggests that these may be a consequence rather than a cause of haemorrhoids.

Rubber band ligation for hemorrhoidal disease can be safely performed in select HIV-positive patients.

Many surgeons have abandoned the use of rubber band ligation for the treatment of hemorrhoids in patients infected with human immunodeficiency virus because of the belief that this procedure could lead to disastrous outcomes. This study was designed to evaluate the safety and efficacy of rubber band ligation in otherwise healthy human immunodeficiency virus-positive patients. A retrospective chart review of healthy human immunodeficiency virus-positive patients who underwent rubber band ligation for symptomatic hemorrhoids between April 1993 and May 2000 was conducted. The study group comprised 11 patients. All patients were male, with a median age of 48 (range, 32-64) years. Mean T-cell helper count was 450 (range, 200-1,000) cells/microl. A median of 2 (range, 1-4) rubber band ligations were performed per patient. The median length of follow-up was seven (range, 1-28) months. There were no deaths or complications in any study group patient. Eight patients (73 percent) had excellent results, with complete resolution of symptoms. Two patients (18 percent) had initial improvement but subsequently had hemorrhoidectomy because of recurrent symptoms. Only one patient (9 percent) had no benefit from rubber band ligation and underwent hemorrhoidectomy. These data suggest that asymptomatic human immunodeficiency virus-positive patients can be treated safely and effectively with rubber band ligation for symptomatic hemorrhoids.

Diagnosis and treatment of haemorrhoids in the elderly: results from 291 patients

Haemorrhoids are believed to be rare in elderly patients, occurring mainly in young and middle-aged subjects. Symptoms of haemorrhoids in elderly patients, in addition, require a precise differential diagnosis in order to rule out neoplasia. In this paper we report our experience in dealing with haemorrhoidal disease in 291 patients older than 65 years. Symptoms of presentation were those commonly reported by younger patients. Accurate clinical examination, proctoscopy and flexible sigmoidoscopy allowed reaching a differential diagnosis in the majority of patients. Extensive colorectal diagnostic screening was required in 28.5% of patients due to the clinical presentation. Treatment was conservative in most cases, with 57.2% of the patients treated medically and 36.7% undergoing rubber band ligation (RBL). In this group of patients no complications occurred although several risk factors were present (e.g. anticoagulant medications, diabetes, cardiovascular diseases). A further 13% of the patients underwent surgery with no complications or mortality. Haemorrhoids in elderly patients occur with features similar to those of other ages and ambulatory treatment can be performed. In particular, RBL can be performed safely even in those patients presenting with associated illness.