Abstract

A COMPARATIVE STUDY OF RUBBER BAND LIGATION AND SCLEROTHERAPY IN PATIENTS WITH SECOND DEGREE HAEMORRHOIDS

Author(s): Selvaraj V, Uma Balakrishnan

BACKGROUND Haemorrhoids are an extremely common surgical condition of anorectal area. With the available non-surgical approaches for haemorrhoids like infrared coagulation, bipolar diathermy, direct current therapy, cryotherapy, etc. the number of haemorrhoidectomies performed has decreased significantly over time.12 Rubber band ligation and injection sclerotherapy have become the mainstays of outpatient treatment for patients presenting with grade 1 to 2 haemorrhoids. MATERIALS AND METHODS The study was carried out between November 2016 and October 2017 over a period of twelve months. A total of 142 patients with second degree haemorrhoids who consented to participate in the study were included. A detailed history was obtained with emphasis on symptoms, occupation and dietary habits. All patients underwent digital rectal examination and proctoscopy. In sclerotherapy group, with the patient in left lateral position, 3 to 5 ml of 5% phenol in groundnut oil was injected into a point above the main mass of haemorrhoid into the sub mucosa, till elevation and pallor of the mucosa was seen. Similarly, in rubber band ligation group one rubber band was applied on each haemorrhoidal bundle on rectal mucosa. Patients were followed up at intervals of 3 weeks, 6 weeks and 9 weeks. At each followup, symptoms of bleeding, prolapse, discomfort, discharge, pruritus / irritation were assessed. Intraoperative pain during the treatment was assessed on a visual analogue scale (VAS) ranging from 1 to 10 with 1 indicating no pain and 10 the worst pain. If the patient was still symptomatic, further treatment given up to a maximum of three times. Patients failing to respond after these three visits for treatment were considered as treatment failure and surgery advised. RESULTS In comparison of rubber band ligation and sclerotherapy, we found out that all the symptoms of haemorrhoids showed improvement over the course of 9 weeks in both treatment groups. Significantly more number of patients in the Rubber band ligation group had excellent symptomatic relief on patient assessment when compared to sclerotherapy group. Shrinkage of haemorrhoids was also significantly less in sclerotherapy group as compared to rubber band ligation group. CONCLUSION It was therefore seen that sclerotherapy is slower to give symptomatic relief of bleeding and prolapse compared to rubber band ligation.