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Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases  [cached]
Ayman M El Nakeeb, Amir A Fikry, Waleed H Omar, Elyamani M Fouda, Tito A El Metwally, Hosam E Ghazy, Sabry A Badr, Mohmed Y Abu Elkhar, Salih M Elawady, Hisham H Abd Elmoniam, Waiel W Khafagy, Mosaad M Morshed, Ramadan E El Lithy, Mohamed E Farid
World Journal of Gastroenterology , 2008,
Abstract: AIM: To study the results for the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) method.METHODS: A retrospective study for 750 patients who came to the colorectal unit from June, 1998 to September, 2006, data was retrieved from archived files. RBL was performed using the Mc Gown applicator on an outpatient basis. The patients were asked to return to out-patient clinic for follow up at 2 wk, 1 mo, 6 mo and through telephone call every 6 mo for 2 years).RESULTS: After RBL, 696 patients (92.8%) were cured with no difference in outcome for second or third degree hemorrhoids (P = 0.31). Symptomatic recurrence was detected in 11.04% after 2 years. A total of 52 patients (6.93%) had 77 complications from RBL which required no hospitalization. Complications were pain, rectal bleeding and vaso-vagal symptoms (4.13%, 4.13% and 1.33% of patients, respectively). At 1 mo there were a significant improvement in mean SF-36 scores over baseline in five items, while after 2 years there were improvement in all items over baseline, but not significant. No significant manometric changes after band ligation.CONCLUSION: RBL is a simple, safe and effective method for treating symptomatic second and third degree hemorrhoids as an out patient procedure with significant improvement in quality of life. RBL doesn’t alter ano-rectal functions.
HEMORRHOIDS
ABDUL MAJID
The Professional Medical Journal , 2006,
Abstract: Objective: To evaluate the therapeutic results of rubber band ligation inhemorrhoidal disease. Design:. Prospective case series with a minimum follow up of six months. Place and durationof study: At surgical out door department of Combined Military Hospital Rawalpindi from January 2002 to July 2003.Patients and methods: One hundred patients with 1st and 2nd degree hemorrhoids were treated by rubber band ligationand injection scelerothrapy in two groups “A” and “B” with 50 patients in each group respectively. They were followedup for six months and therapeutic effects were assessed by improvement in symptom severity score, post procedurecomplications and number of off days from work. Results: In group “A” 38(76%) patients were cured, 7(14%) showedimprovement and 5(10%) showed no improvement. While in group “B” 25(50%) patients were cured, 13(26%) showedimprovement and 12(24%) showed no improvement. In group “A” complications occurred in 15 patients and in group“B” complications occurred in 27 patients, however no serious and life threatening complications were seen. Conclusion:Rubber band ligation is a rapid, safe, effective and economical method of treating 1st and 2nd degree Hemorrhoids inout door
The Elastic Ligation of Internal Hemorrhoids: Where Are We Now?  [PDF]
H. Abid, G. Ousseur, R. Benjira, M. Lahlali, A. Lamine, N. Lahmidani, M. El Yousfi, N. Aqodad, D. Benajah, A. Ibrahimi, M. El Abkari
Open Journal of Gastroenterology (OJGas) , 2019, DOI: 10.4236/ojgas.2019.91005
Abstract: Hemorrhoidal disease requires different means of treatment: medical, surgical and instrumental. Among these, the elastic ligature seems to be an effective and widespread technique in the world. The aim of our study is to report our experience in methodology and short and medium term results of ligation in a population that strongly fears surgery. Patients and Methods: It’s about a retrospective and descriptive study of 208 outpatients treated with elastic ligations for symptomatic internal hemorrhoids. These patients were collected over a period of 15 years (October 2003-April 2018) at the gastroenterology department of Hassan II CHU in Fez. Results: The average age of our patients was 50.3 years [20 - 82 years] with a sex-ratio M/F of 2.85. The clinical signs were dominated by rectorrhagia (99%) complicated by anemia in 116 cases requiring blood transfusion in 72 cases, followed by proctalgia (27.4%). Transit disorders were noted in 65 patients (31.2%). Indications for elastic ligation were symptomatic internal hemorrhoids Grade 3 (65.4%) and Grade 2 (34.6%). The average number of ligation sessions that achieved the therapeutic goal was 2.30 sessions [1 - 4]. The average number of rings per session was 3.1 rings [1 - 6]. Moderate to severe pain was reported by 20 patients (9.6%) mostly within 6 hours of ligation. Minimal rectorrhagia was reported in 33 cases (15.8%). There were no major complications who required a hospitalization. The success rate was 80.7% (n = 168). Surgery was performed in 31 patients (14.9%) and sclerosis in 7 patients (3.3%). Conclusion: The elastic ligation of internal hemorrhoids remains an effective and inexpensive technique when it comes to the treatment of symptomatic internal hemorrhoids of Grade 2 to 3. The results obtained in our study were very reassuring and motivating.
Rubber band ligation of hemorrhoids - An Office Procedure
Katerina Kotzampassi .
Annals of Gastroenterology , 2007,
Abstract: SUMMARY Rubber band ligation [RBL] is one of the most popular nonsurgical procedures available for hemorrhoids. The aim of this study was to prospectively evaluate the effectiveness of RBL in respect to eradication percentages, post-procedure pain, and complications as well as the simplicity of the technique. Eighty-seven patients with 2nd and 3rd degree internal symptomatic hemorrhoids - denying surgical procedure - were enrolled in this study. Four patients stopped treatment after the 1st session; 24 patients required one banding session [3 bands]; 49 patients two sessions [mean 5.36 bands] and 14 patients three sessions [mean 6.78 bands]. Forty-two patients [rate 52.5%] experienced no pain at all; 25 patients [31.2%] slight pain and 13 [16.2%] moderate pain, needing analgesics. There were three complications, all managed conservatively: one bleeding, one thrombosis and one patient experienced severe rectal pain. After termination of the treatment, and for a one-year follow up, hemorrhoids remained reduced by at least one grade, in comparison with that of the initial assessment. We conclude that rubber band ligation is a safe and effective procedure, easy to perform, thus it is advised as an office-procedure for hemorrhoid treatment.
Ligation and mucopexy for prolapsing hemorrhoids – a ten year experience
Pravin J Gupta, Surekha Kalaskar
Annals of Surgical Innovation and Research , 2008, DOI: 10.1186/1750-1164-2-5
Abstract: 616 patients (255 females) complaining of symptoms of hemorrhoids were included in the study. The hemorrhoids were suture ligated with an absorbable suture material under vision. Operating time, postoperative complications, time to return to work, and outcome of the procedure were analyzed. Follow-up was planned following discharge after 1 month, 6 months and after at least 1 year. Patient satisfaction was also assessed.The mean procedure time was 8 ± 0 minutes (range, 6–15 minutes), and the total admission period was 12 ± 4 Hours. Perianal thrombosis and skin tags were the commonest post-operative complications. The mean total analgesic dose and duration of pain control using analgesics was 19 ± 4 tablets, and 9 ± 3 days respectively.The postoperative follow up after 4 weeks revealed therapeutic success in 589 patients (95.6%), who presented with hemorrhoidal bleeding. Prolapse was no longer observed in 98% of patients and 96% patients experienced no pain after defecation. 93% patients completed the one-year follow-up and 89 percent of them were asymptomatic. The patient satisfaction scoring was 8.2% on visual analogue scale.Suture ligation and mucopexy of hemorrhoids is an easy-to-perform technique that is well accepted by patients and has good results for prolapsing hemorrhoids.Many therapeutic options exist for the treatment of symptomatic hemorrhoids; among them are dietary and lifestyle modifications and office treatment such as infrared coagulation, sclerotherapy, rubber band ligation, hemorrhoidal artery ligation, or various stapling and excisional procedures [1].We describe a simpler technique for the reduction of the size of the hemorrhoids with control of bleeding and prolapse, which we term as ligation and mucopexy of the hemorrhoids under vision. This technique is based on the fact that the hemorrhoidal vessels have a constant anatomical location. Usually, they penetrate the hemorrhoid pile in the base. A stitch that is put on the base of the hemorrhoid
Radioablation and suture fixation of advanced grades of hemorrhoids: An effective alternative to staplers and Doppler guided ligation of hemorrhoids
Gupta,P. J.;
Revista Espa?ola de Enfermedades Digestivas , 2006, DOI: 10.4321/S1130-01082006001000003
Abstract: background: for advance grades of symptomatic hemorrhoids (grade iii and iv) the author has innovated a procedure called radiofrequency ablation and fixation of hemorrhoids. the procedure is performed as a day care surgery. patients and methods: the surgical technique and clinical follow-up of patients operated by this technique are presented. an ellman dual frequency radiofrequency generator was used for ablation, which was followed by suture fixation of the hemorrhoids. patient satisfaction score was assessed using a visual analogue scale. the results of this procedure are presented and are compared with the results of published data of stapled hemorrhoidopexy and doppler guided hemorrhoidal artery ligation procedures. results: between 1998 and 2005, 2,376 patients were operated with this technique. patient's mean age was 34 years and 1,438 patients were males. the postoperative complication rate was 3.5%, which included secondary bleeding, retention of urine and perianal thrombosis. the recurrence rate was less than 1.5%. the satisfaction score was 9.2 on vas. conclusions: radiofrequency ablation and fixation of hemorrhoids is a technique that results in less postoperative pain, shorter hospital stay, and early return to normal activity. it seems to be a better alternative to stapled hemorrhoidopexy or doppler guided hemorrhoidal artery ligation with regard to effectiveness and symptomatic relief on long term.
Infrared coagulation versus rubber band ligation in early stage hemorrhoids
Gupta, P.J.;
Brazilian Journal of Medical and Biological Research , 2003, DOI: 10.1590/S0100-879X2003001000022
Abstract: the ideal therapy for early stages of hemorrhoids is always debated. some are more effective but are more painful, others are less painful but their efficacy is also lower. thus, comfort or efficacy is a major concern. in the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. one hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (n = 54) or infrared coagulation (n = 46). parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. the mean age was 38 years (range 19-68 years). the mean duration of disease was 17.5 months (range 12 to 34 months). the number of male patients was double that of females. postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). post-defecation pain was more intense with band ligation and so was rectal tenesmus (p = 0.0059). the patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, p = 0.03), but also had a higher recurrence or failure rate (p = 0.03). thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. as infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.
Infrared coagulation versus rubber band ligation in early stage hemorrhoids  [cached]
Gupta P.J.
Brazilian Journal of Medical and Biological Research , 2003,
Abstract: The ideal therapy for early stages of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but their efficacy is also lower. Thus, comfort or efficacy is a major concern. In the present randomized study, a comparison is made between infrared coagulation and rubber band ligation in terms of effectiveness and discomfort. One hundred patients with second degree bleeding piles were randomized prospectively to either rubber band ligation (N = 54) or infrared coagulation (N = 46). Parameters measured included postoperative discomfort and pain, time to return to work, relief in incidence of bleeding, and recurrence rate. The mean age was 38 years (range 19-68 years). The mean duration of disease was 17.5 months (range 12 to 34 months). The number of male patients was double that of females. Postoperative pain during the first week was more intense in the band ligation group (2-5 vs 0-3 on a visual analogue scale). Post-defecation pain was more intense with band ligation and so was rectal tenesmus (P = 0.0059). The patients in the infrared coagulation group resumed their duties earlier (2 vs 4 days, P = 0.03), but also had a higher recurrence or failure rate (P = 0.03). Thus, we conclude that band ligation, although more effective in controlling symptoms and obliterating hemorrhoids, is associated with more pain and discomfort to the patient. As infrared coagulation can be conveniently repeated in case of recurrence, it could be considered to be a suitable alternative office procedure for the treatment of early stage hemorrhoids.
Comparison between Ultroid and Rubber Band Ligation in Treatment of Internal Hemorrhoids
Rasoul Azizi,Behzad Rabani-Karizi,Mohammad Ali Taghipour
Acta Medica Iranica , 2010,
Abstract: "nHemorrhoid is one of the most common surgical diseases and different methods are available for its treatment. This study is a comparison between two methods of treatment of internal hemorrhoid, Monopolar low voltage instrument (Ultroid) and Rubber Band Ligation. This method has been carried out prospectively in which 50 patients who were treated with rubber band ligation and 50 patients with Ultroid were compared according to the incidence of complications, post-operative pain and treatment response. According to this study complete success rate with Ultroid was 82% and partial success rate was 10% and no response to treatment was seen in 8%. In Rubber Band method the complete response rate was 94% (P=0.2). With Ultroid, 74% of patient reported no postoperative pain, 24% reported mild and moderate pain and 2% of patients complained of severe pain. With Rubber band ligation, 72% of patients reported no post-operative pain, 26% reported mild and moderate pain and 1% complained of severe pain (P=0.00). Rubber Band ligation and Ultroid are both considered as outpatient procedures for treatment of hemorrhoids. Both methods are mostly used for grade 1, 2 and sometime grade 3 hemorrhoids. In Ultroid method the operator is required to hold the probe for a period of time, and in most cases, the surgeon should spend between 20-25 minutes for the coagulation of three piles. Some surgeons do not have patience for this modality of internal hemorrhoid treatment. In this study we achieved acceptable results comparable with those of other techniques.
Doppler-guided hemorrhoidal artery ligation in the management of symptomatic hemorrhoids
Ramírez,J. M.; Aguilella,V.; Elía,M.; Gracia,J. A.; Martínez,M.;
Revista Espa?ola de Enfermedades Digestivas , 2005, DOI: 10.4321/S1130-01082005000200004
Abstract: objective: the aim of this study is to clinically test the efficacy of a new approach for patients having symptomatic grade iii and iv hemorrhoids. material and method: 32 patients (17 females) complaining of grade iii or iv hemorrhoids were included in the study. a specially designed proctoscope coupled with a doppler transducer on its tip was used to identify the hemorrhoidal arteries, which were afterwards suture ligated. operating time as well as per- and post-operative complications were anlyzed. follow-up was planned following discharge after 1 week, 1 month, 6 months and 1 year. results: mean operation time was 27 (range 18-43) minutes, and 5 (range 4-7) arteries were located on average. no patient had severe or moderate postoperative pain, with anal discomfort being the main complaint. rectal bleeding and tenesmus were the commonest post-operative complications. after one year of follow-up, 19 patients were free of symptoms and 6 of them had significant symptom relief. according to grade, the technique failed in just 3 grade iii patients, but in as many as 4 grade iv hemorrhoid cases. conclusions: doppler-guided hemorrhoid artery ligation is an easy-to-perform technique that is well accepted by patients and has good results for grade iii hemorrhoids.
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