Rubber band ligation versus haemorrhoidectomy for the treatment of grade II–III haemorrhoids: a systematic review and meta-analysis of randomised controlled trials

Abstract

Background The aim of this study was to review clinical outcome of haemorrhoidectomy and rubber band ligation in grade II–III haemorrhoids. Methods A systematic review was conducted. Medline, Embase, Cochrane Library, Clinicaltrials.gov, and the WHO International Trial Registry Platform were searched, from inception until May 2018, to identify randomised clinical trials comparing rubber band ligation with haemorrhoidectomy for grade II–III haemorrhoids. The primary outcome was control of symptoms. Secondary outcomes included postoperative pain, postoperative complications, anal continence, patient satisfaction, quality of life and healthcare costs were assessed. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Results Three hundred and twenty-four studies were identified. Eight trials met the inclusion criteria. All trials were of moderate methodological quality. Outcome measures were diverse and not clearly defined. Control of symptoms was better following haemorrhoidectomy. Patients had less pain after rubber band ligation. There were more complications (bleeding, urinary retention, anal incontinence/stenosis) in the haemorrhoidectomy group. Patient satisfaction was equal in both groups. There were no data on quality of life and healthcare costs except that in one study patients resumed work more early after rubber band ligation. Conclusions Haemorrhoidectomy seems to provide better symptom control but at the cost of more pain and complications. However, due to the poor quality of the studies analysed/it is not possible to determine which of the two procedures provides the best treatment for grade II–III haemorrhoids. Further studies focusing on clearly defined outcome measurements taking patients perspective and economic impact into consideration are required.

Treatment of Hemorrhoids with Rubber Band Ligation (Rbl) In A Single Outpatient Centre. Suggestions of Treatment in Sars-Covid Age

“…This result is lower than Ayman et al [25] who found this complication in ten cases (1.33 %) in their study. Dekker [2] reported a urinary retention more often after haemorrhoidectomy (2-34%) than after RBL (0-0.4%).…”

“…As reported in literature no patient with incontinence was observed [2]. In 3 studies anal incontinence was reported from 0 to 7.7% after surgical haemorrhoidectomy but this was not reported after RBL [31][32][33].…”

“…Finally, data regarding health-care costs from other studies is sparse. Cost analysis has been carried out in one trial comparing stapled haemorrhoidopexy with RBL, with the cost of stapled haemorrhoidopexy being substantially higher and unlikely to be considered cost-effective at 1 year [2].…”

“…This condition often leads to disruption in an individual's personal and working life. Management has considerable cost implications, and therefore, economic consequences [2].…”

Rubber band ligation versus coagulation for the treatment of haemorrhoids: a meta-analysis of randomised controlled trials

“…Usually, patients with grade I and II and select patients with grade III haemorrhoids can be effectively treated with non-surgical therapies 3. Compared with surgical therapies, non-surgical therapies have the advantage of lower postoperative pain and complication rates, although the long-term efficacy is not as good as surgical therapies 4. Non-surgical therapies include rubber band ligation (RBL), sclerotherapy and coagulation,3 and they can all be performed via an anoscopy, proctoscopy or endoscopy.…”