Rubber band ligation of symptomatic hemorrhoids: an old solution to an everyday problem.

PURPOSE

The aim of this prospective study is to present the results of rubber band ligation (RBL) in 2635 consecutive patients with 2, 3, and 4 degree symptomatic hemorrhoids, the pain risk factors, and the applicability of the method in patients with liver cirrhosis and portal hypertension.

METHODS

A total of 1256 patients with 2, 1159 with 3, and 220 with 4 degree hemorrhoids were included in the study. Fifty-seven patients with hemorrhoids had liver cirrhosis and portal hypertension. RBL was performed using St Marks', McGinvey, and suction ligators. Single ligation was done in 178 patients, while 2457 patients had synchronous multiple ligations, in one (272), two (1289), and three (896 patients) sessions.

RESULTS

After the end of treatment, 86.8% of our patients were asymptomatic and 84.5% remained asymptomatic 2 years later. A total of 593 patients had complications. Thirty required hospitalization, while pain was the most frequent complication (16.16 %). Multiple banding, young age, male sex, and external hemorrhoids were pain risk factors. RBL proved to be safe in 57 patients with coagulation disorders due to cirrhosis. Symptomatic recurrence was detected in 327 out of 2110 patients (15.49%), with repeat RBL in 219 cases and surgery in 108 cases.

CONCLUSION

RBL is a safe, effective method for treating symptomatic 2 and 3 degree hemorrhoids. It can also be applied in selected cases of 4 degree hemorrhoids and patients with cirrhosis and portal hypertension.