Randomized Trial of Rubber Band Ligation vs. Stapled Hemorrhoidectomy for Prolapsed Piles

Abstract

Stapled hemorrhoidectomy is associated with more pain and minor morbidity than rubber band ligation in the treatment of Grade III and small Grade IV piles. However, for those patients who do not want the risk of further intervention procedures, stapled hemorrhoidectomy offers the better chance of a symptomatic cure.

Documented Complications of Staple Hemorrhoidopexy: A Systematic Review

“…Postoperative bleeding was the most commonly reported complication; however, these rates were lower when compared with other methods of hemorrhoidectomy. 47,56 Bleeding following stapled hemorrhoidopexy is said to most commonly occur immediately after surgery or from day 7 onwards. It has been suggested that bleeding often occurs secondary to an arteriolar bleed along the staple line, from defective techniques that result in injury to the mucosa and may also be secondary to inflammation and/or rejection of the staples when the procedure is completed during a period of anusitis.…”

“…5,54,55 The judicious careful use of an Eisenhammer retractor for purse string suture insertion has been shown to reduce the incidence of these complications. 56,57 Soiling and mucus discharge was also documented. 4,9,30,32,46 Fecal urgency was also noted with an incidence range of 0.2 to 25% of cases.…”

“…The rate of residual skin tags and recurrence has been shown to be considerably higher than other methods of hemorrhoidectomy, but in line with the rates seen in rubber band ligation. 44,56,59 Residual skin tags have been suggested to shrink in size following stapled hemorrhoidopexy, although many studies do not support this finding. 46,60 It has been suggested that via the use of a purse-string suture approximately 2.5 cm above the dentate line, it is possible to lift both the prolapsed internal hemorrhoids and also the exter- 61 Excision of residual perianal skin tags is also practiced, but may possibly result in increased postoperative discomfort.…”

“…When compared with rubber band ligation however, it is suggested that the procedure is associated with a higher level of pain. 56 There is also reference to prolonged pain lasting greater than 15 months. Although the etiology remains unclear, postulated causes included the incorporation of smooth muscle into the doughnut and the induction of a staple line inflammatory response in the rectal ampulla resulting in irritability and pain.…”

Comparative Study of Staging Rubber Band Ligation (RBL) and Hemorrhoidectomy in Treatment of Forth Degree Hemorrhoids

“…Now it is the procedure of choice for patients who did not respond to office-based procedures or who unable to tolerate these procedures, grade three or four hemorrhoids, or patients with substantial external skin tags (5). Rubber band ligation is also widely used because it is a safe and effective method, involves less postoperative pain, and causes a quick recovery (9,(11)(12)(13). Complications are mostly minor.…”