Stavrou George, Tzikos Georgios, Malliou Petra, Panidis Stavros, Kotzampassi Katerina
Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece (George Stavrou, Georgios Tzikos, Petra Malliou, Stavros Panidis, Katerina Kotzampassi).
Ann Gastroenterol. 2022 Sep-Oct;35(5):509-513. doi: 10.20524/aog.2022.0737. Epub 2022 Jul 15.
Rubber band ligation (RBL) is an effective, well-established, non-surgical option for symptomatic grade II-III hemorrhoid treatment. However, few reports exist about the benefit and risks of RBL in high-risk patients. We herein evaluated the effectiveness and safety of RBL in hemophiliac, human immunodeficiency virus (HIV)-positive and pregnant patients vs. other patients.
We retrospectively evaluated the effectiveness of RBL, during the period 2001-2021, in 3 distinct patient categories deemed high-risk and thus not suitable for anesthesia and/or surgical management of their hemorrhoids: hemophiliacs, HIV-positive patients, and pregnant women. These were compared to matched controls, selected from our outpatient pool, who had no major comorbidities and who had opted for RBL as the primary method of treatment.
There were 3 study groups (44 with hemophilia, 29 HIV-positive patients, and 45 pregnant women) and controls respectively matched for grade, sex and age (2 for each one in the study groups). Hemophilia patients needed up to 6 RBL sessions for relief of symptoms (3.22 sessions/patient) compared to controls, who needed up to 4 sessions (1.88 sessions/patient, P<0.001); in the other 2 groups there was no difference. There were 3 minor complications: one minor bleeding in a hemophilia patient, a thrombosis in an HIV-positive patient, and severe rectal pain in a control patient. Patients were followed-up for at least 1 year.
RBL is a safe and effective procedure in hemophiliacs, HIV-positive patients and pregnant women, with low complication rates for grade I-III hemorrhoids, similar to those in healthy matched controls.
橡皮圈套扎术（RBL）是治疗有症状的II - III级痔疮的一种有效、成熟的非手术选择。然而，关于RBL在高危患者中的益处和风险的报道很少。我们在此评估了RBL在血友病患者、人类免疫缺陷病毒（HIV）阳性患者和孕妇与其他患者中的有效性和安全性。
我们回顾性评估了2001年至2021年期间RBL在3类被视为高危因而不适合对其痔疮进行麻醉和/或手术治疗的不同患者中的有效性：血友病患者、HIV阳性患者和孕妇。将这些患者与从我们的门诊患者中挑选出的匹配对照组进行比较，这些对照组没有重大合并症，并且选择RBL作为主要治疗方法。
有3个研究组（44例血友病患者、29例HIV阳性患者和45例孕妇）以及分别在分级、性别和年龄上匹配的对照组（每个研究组各2例）。与对照组相比，血友病患者缓解症状最多需要6次RBL治疗（每位患者3.22次治疗），而对照组最多需要4次治疗（每位患者1.88次治疗，P<0.001）；在其他2组中没有差异。有3例轻微并发症：1例血友病患者轻微出血、1例HIV阳性患者血栓形成和1例对照患者严重直肠疼痛。患者至少随访1年。
RBL在血友病患者、HIV阳性患者和孕妇中是一种安全有效的手术，I - III级痔疮的并发症发生率较低，与健康匹配对照组相似。
