Advanced Approaches to Rubber Band Ligation in Treatment of Hemorrhoidal Disease in the Elderly and Senile Outpatients

Abstract

Introduction. Currently, rubber band ligation of internal hemorrhoids is performed during surgical treatment of hemorrhoids in 26,8844,0 % of cases. However, this technique can lead to the need for repeated interventions. Moreover, at stage IV hemorrhoids a relapse occurs in almost 40% of cases.The aim of the study was to improve clinical outcomes of the senile and elderly outpatients with stage II-III internal hemorrhoids by optimizing a rubber band ligation technique and indications for its use.Materials and methods. The authors analyzed clinical outcomes of 60 senile and elderly outpatients with stage II-III internal hemorrhoids. Patients were divided into 2 study groups. Patients of the control group received standard treatment including ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal 0.8 atm. Patients of the case group were exposed to ligation of hemorrhoidal nodes with latex ligatures using a KARL STORZ suction ligature instrument with an integrated vacuum pump at a pressure equal to 0,60,7 atm. Ligation in the case group was performed on the following conditions: high and medium degree of compliance in patients, hemorrhoids size less than 1,5 cm, absence of anemia, no antiplatelet drug intake a possibility to discontinue an antiplatelet drug in case it is takenResults. The study results demonstrated that 60 % of patients of the case group required pain relief on Day 1 after the intervention, 13,3% of patients of the case group required pain relief on Day 3 after the intervention. The correspondence to these parameters in the control group was 66,6% and 16,6% of patients respectively. The first defecation in patients of the case group occurred in 1,73 0,48 days on average; in patients of the control group in 1,74 0,47 days. Acute swelling of the external hemorrhoids was reported in 13,3% of patients of the case group and in 16,7% patients of the control group. Thrombosed external hemorrhoids, rectal bleeding, acute urinary retention were reported in 6,7% of patients of the case group and in 10,0% of patients of the control group. Vaso-vagal syndrome and local wound complications were reported in 6,7% of patients of the case group and in 3,3% of patients of the control group. Stricture of the anal canal was noted in 3,3% of patients of the case group and in 3,3% of patients of the control group. Anal sphincter incompetence was not detected in patients of the case group, while it was reported in 3,3% of patients of the control group. The average time of temporary disability was 2,3 0,4 days in patients of the control group and 1,9 0,4 days in patients of the case group. In 6 months after ligation, 60,0% of patients of the control group and 63,3% of patients of the case group manifested good results; 30,0% and 33,3% manifested satisfactory results; and 10,0% and 3,3% manifested unsatisfactory results respectively. After rubber band ligation, the relapse rate of the disease was 13,3% in patients of the control group and 10,0% in patients of the case group.Conclusion. Rubber band ligation is well tolerated by the senile and elderly patients. To reduce pain, tenesmus, vaso-vagal conditions, and urinary retention, the negative pressure created in the device sleeve degressed, which resulted in an improvement of patients general state and decrease in the number of complications.