Rubber band ligation or lateral subcutaneous sphincterotomy for treatment of haemorrhoids

Abstract

SUMMARYA randomized trial has been conducted to compare treatment for first-and second-degree haemorrhoids by rubber band ligation and lateral subcutaneous sphincterotomy. The symptomatic results of both procedures were similar at one year, though the initial results of sphincterotomy were poor. Eleven patients later required haemorrhoidectomy-5after lateralsubcutaneoussphincterotomy and 6 after rubber band ligation. Rebanding was necessary in I1 patients treated by rubber band ligation (22 per cent). Immediate complications of pain and bleeding were reported in 27 per cent of patients treated by rubber band ligation compared with 14 per cent after lateral subcutaneous sphincterotomy, whereas 2 patients developed a fistula a/ier lateral subcutaneous sphincterotomy .Lateral subcutaneous sphincterotomy was associated with a 30 per cent reduction in anal sphincter pressure at 4 4 months and the anal pressure was also reduced (by 24 per cent) at I year. Rubber band ligation had no influence on anal pressure.The poor results of lateral subcutaneous sphincterotomy occurred in patients with prolapse and with anal pressures of less than 100 cm H,O. Although lateral subcutaneous sphincterotomy is a satisfactory means of treating patients with first-and second-degree haemorrhoids, it requires admission to a day case unit. For this reason lateral subcutaneous sphincberotomy is unlikely to be preferred to rubber band ligation in the outpatient management of piles.THE long term results of conservative therapy for firstand second-degree piles indicate that haemorrhoidectomy can usually be avoided in 90 per cent of patients (Hancock and Smith, 1975;Steinberg et al., 1975;Kaufman, 1976). During the past decade there has been an increasing tendency to use minor outpatient procedures for treatment of haemorrhoids (Leading Article, 1975). Haemorrhoids may be treated by reducing mucosal prolapse by injection (Blanchard, 1928), rubber band ligation (Barron, 1963) or cryosurgery (Lewis et al., 1969), or by reducing the activity of the internal sphincter by manual dilatation of the anus (Lord, 1969) or lateral subcutaneous sphincterotomy (Notaras, 1971). The rationale of these last two procedures is based upon the belief that the internal sphincter is overactive in patients with haemorrhoids (Hancock, 1976).A trial to compare rubber bandligation with manual dilatation of the anus has already been conducted in this clinic (Hood and Alexander-Williams, 1971). The short term results indicated that rubber band ligation was significantly more effective. However, over half the patients receiving rubber band ligation in this study had to attend outpatients at least three times Furthermore, manual dilatation has been criticized because it is imprecise (Eisenhammer, 1953) and may cause anal prolapse in the elderly (Bates, 1972).We have therefore undertaken a study to compare multiple rubber band ligation at one outpatient visit using the Baron applicator with lateral subcutaneous sphincterotomy performed as a day case. Patients and methodsO...

Anorectal function and clinical outcome after open and closed haemorrhoidectomy, with and without internal sphincterotomy. A prospective study

“…Even if not significant, a change in voluntary con- 20 traction was more evident after F operation. Anal ultrasound…”

“…However, the results are controversial [10]. Finally, with the aim to reduce postoperative pain, lateral internal sphincterotomy has also been associated with haemorrhoidectomy, but this is thought to affect anal continence after surgery [20,21].…”

The evaluation and physiologic assessment of hemorrhoidal disease: a review

“…Overall, younger patients and men have high maximum resting pressures [3][4][5][6][7][8]. Prolapsing hemorrhoids are associated with lower resting pressures than are non-prolapsing hemorrhoids [8][9][10]. The pressure reverts to normal after hemorrhoidectomy [6,[11][12], although not after rubber band ligation [9,13] or cryosurgery [5].…”

Elastic band ligation of hemorrhoids using flexible gastroscope

“…Although it is not associated with the problems that follow the typical surgical treatment of hemorrhoids. [7][8][9][10] The RBL method is not free of complications and even deaths have been reported in immunosuppressed patients. 11,12 Though considered as a safe, simple and effective procedure, studies show complications like recurrence, pain, bleeding and even pelvic sepsis in some cases.…”