[Optimization of the Barron ligature treatment of 2nd and 3rd-degree hemorrhoids using a therapeutic troika].

Due to the fact that the intensity of haemorrhoidal complaints may rapidly change, also numerous therapeutic approaches of minor effectiveness are considered a helpful remedy. However, the advantage of the Barron-ligature is not seriously doubted. By placing it correctly at the insensitive distal rectum, haemorrhoidal operations are only necessary in very advanced stages. Can the Barron ligature be optimized even more? Three patient groups consisting of 120 patients with 2nd degree haemorrhoids who were simultaneously treated by anal dilation using an appropriate lubricant for the anal dilator, were compared with each other in a randomized, open, placebo-controlled study conducted in two centres. In these groups treatment consisted of: rubber-band ligature alone rubber-band ligature and anal dilator and Kamillosan ointment rubber-band ligature and anal dilator and vaseline The observation period comprised six weeks. Every two weeks a check was made. Assessment criteria were: light-red haemorrhage, itching, oozing, sensation of incomplete evacuation, nodal prolapse and slight staining after defecation The pressure ratios of the closing apparatus were investigated at the beginning and end of the study. The group who had been treated with rubber-band ligature, anal dilator and Kamillosan ointment showed the best results. By simultaneously applying the rubber-band ligature, anal dilator and Kamillosan ointment as a lubricant, significantly better results could be obtained. The findings are based on a former retrospective study carried out in 500 patients with 2nd degree haemorrhoids. In this study by applying the anal dilator and Kamillosan ointment, the number of treatments could significantly be reduced from 5.95 to 4.2 and the number of necessary ligatures from 3.8 to 2.76 which, also from the economic point of view, was favourable.