DOI: http://dx.doi.org/10.18203/2349-2902.isj20201849

Comparison of single versus double versus triple site band ligation for haemorrhoids in a single visit: a case-controlled double blind randomized study

Neeraj K. Dewanda, Rohit Babal, Harsh Kumar, Deshraj Chawla

Abstract


Background: Rubber band ligation is considered one of the most popular non-surgical procedures available, representing the most reasonable balance between efficacy, pain and potential of complication. The present study was a controlled double blinded randomized study to compare Single versus double versus triple site band ligation for haemorrhoids in single treatment visit with special regards to its safety and efficacy in our patient population.

Methods: There were 78 patients equally randomized in three groups by closed enveloped method. The number of patients in each group was 26, In Group A, a single, in Group B, two, and in Group C three major haemorrhoidal groups were rubber band ligated, in a single treatment visit on outpatient basis under topical anaesthesia with lignocaine 2% jelly.

Results: Rubber band ligation was effective with significant symptom improvement seen in all patients with 88% patient satisfaction at end of 30 days period. Post ligation pain score and number of analgesic requirement in immediate post band ligation period, at 12 hours, at 1,7,14, 21 and 30 days post band ligation were similar in all three groups with p value >0.05. Multiple site haemorrhoidal bandings was done safely at single session without severe discomfort, pain or bleeding or severe complications requiring hospitalization.

Conclusions: The study finding shows that triple site band ligation in a single session is a safe way of treating symptomatic haemorrhoids with similar post-procedure pain and patient satisfaction as conventional single or double site band ligation.


Keywords


Band Ligation, Haemorrhoids, Triple site ligation

Full Text:

PDF

References


Austin George Acheson, Oliver Cheong Tsen Ng. Haemorrhoidal disease: Keighley MRB, Williams NS, Surgery of Anus, rectum and colon. 4th ed. London: Elsevier. 2019: 195-219.

Barron J. Office ligation of internal haemorrhoids. Am J Surg 1963;105:563-70.

Bleday R, Pena JP, Rothenberger DA, Goldberg SM, Buls JG. Symptomatic hemorrhoids:Current incidence and complications of operative therapy. Dis Colon Rectum. 1992;35(5):477-81.

Corman ML. Hemorrhoids. In: Brian Brown, Erin McMullan and Michelle M LaPlante. Colon and Rectal Surgery. 1. 5th ed. Philadelphia: Lippincort Williams & Wilkins; 2004: 177-244.

Bernal JC, Enguix M, LópezGarcía J, García Romero J, TrullenquePeris R. Rubber-band ligation for hemorrhoids in a colorectal unit. A prospective study. Rev Esp Enferm Dig. 2005;97(1):38-45.

El Nakeeb AM, Fikry AA, Omar WH, Fouda EM, El Metwally TA, Ghazy HE, et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World J Gastroenterol. 2008;14(42):6525-30.

Forlini A, Manzelli A, Quaresima S, Forlini M. Long-term result after rubber band ligation for haemorrhoids. Int J Colorectal Dis. Sep 2009;24(9):1007-10.

Reese GE, von Roon AC, Tekkis PP. Haemorrhoids. Clin Evid. Jan 2009;29:0415.

Russell RCG, Norman S. Williams, Christopher J. K. Bulstrode. Bailey and Love‟s Short Practice of Surgery, 25th ed. 2019;72:1255-62.

Townsend CM, Beauchamp Daniel, Evers Mark, Mattox KL, Sabiston textbook of surgery 19th edition, Elsevier Inc. 2012: 1387-1388.

Michael Z, Stanley A. Maingot’s abdominal operations. 11th ed. 2007:1309.

Bartizal J, Slosberg PA. An alternative to hemorrhoidectomy. Arch Surg. 1977;112(4):534-6.

Murie JA, Sim AJ, Mackenzie I. Rubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: a long term prospective clinical trial. Br J Surg. 1982;69(9):536-8.

Su MY, Chiu CT, Wu CS, Ho YP, Lien JM, Tung SY, et al. Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids. Gastrointest Endosc. 2003;58(6):871-4.

Lee HH, Spencer RJ, Beart RW, Multiplehemorrhoidal bandings in a single session. Dis Colon Rectum 1994;37(1):37-41.

Wong, DL, Hockenberry-Eaton M, Wilson D, Winkelstein ML. Schwartz P.Wong’s Essentials of Pediatric Nursing. 6th ed, Mosby, Inc., St. Louis, MO, 2001:1301.

Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: A comparative analysis of infrared coagulation, rubber band ligation and injection sclerotherapy. Am J Gastroenterol. 1992;87:1601-6.

MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities: a meta-analysis. Dis Colon Rectum. 1995;38:687-94.

Wechter DG, Luna GK. An unusual complication of rubber band ligation of haemorrhoid. 1987;30:137-40.

Khubchandani IT: A randomized comparison of single and multiple rubber band ligations. Dis Colon Rectum. 1983;26:705-8.

Poon GP, Chu KW, Lau WY. Conventional vs triple rubber band ligation for hemorrhoids –A prospective randomized trial, Dis Colon Rectum. 1986;29(12):836-8.

Gehamy RA, Weakley FL. Internal hemorrhoidectomy by elastic ligation. Dis Colon Rect. 1974;17(3):347-53.

Hardwick RH, Durdey P. Should rubber band ligation of hemorrhoids be performed at the initial outpatient visit? Ann R Coll Surg Engl. 1994;76:185-7.

Guy RJ, Seow Cheon F septic complication after treatment of haemorrhoids. Br J Surg. 2003;90:147-56.

Groves AR, Evans JC, Williams JA. Management of Internal Haemorrhoids by Rubber Band Ligation. Br J Surg. 1971;58(12):923-4.