Factors Affecting The Success Rate of Rubber Band Ligation in Haemorrhoid Treatment

ABSTRACT INTRODUCTION: The aim of this study was to statistically evaluate the use of rubber band ligation (RBL) for the treatment of haemorrhoids, as well as to determine the factors affecting the success of this treatment and to provide recommendations for the most appropriate treatment methods based on those factors METHODS: The study included patients who received a follow up after undergoing a band ligation procedure between June 2015 and June 2018 in the hospital’s general surgery clinic. Patient’s sex, age, BMI and satisfaction were assessed, along with duration of symptoms, duration of treatment, haemorrhoid grade, follow up period, rebanding rate, examination findings, complications, and constipation score. RESULTS: A total of 106 patients, 80 males (75.5%) and 26 females (24.5%), were included in the study. The mean follow up period was 29.9 ± 13.5 months, the mean age of patients was 44.2 ± 12.5 years and the mean BMI was 29.2 ± 4.7. The mean duration of symptoms was 8.9 ± 7.6 years and the mean duration of treatment was 6.5 ± 6.2 months. Forty-nine patients (47.1%) had grade 2 haemorrhoids and 55 patients (52.9%) had grade 3 haemorrhoids. Haemorrhoid grade, constipation score and increase in anal tonus were determined to be factors that significantly affected haemorrhoid relapse. Moreover, patient satisfaction was lower in patients with higher constipation score or increased anal tonus. DISCUSSION AND CONCLUSION: Band ligation is a safe, effective treatment for haemorrhoids that can be applied easily to most patients, however, it may not be the first choice for all patients. Alternative procedures may be recommended for patients with higher constipation scores or increased anal tonus, as these factors may affect success for those patient groups.

Hemoroidde Lastik Band Ligasyonu Sonuçlarını Etkileyen Faktörler

ÖZ GİRİŞ ve AMAÇ: Lastik band ligasyonu yaptığımz hastalarımızın bulgularını ve sonuçlarını istatistiki olarak değerlendirmek, tedavinin sonucunu etkileyen faktörleri belirlemek ve hangi hastalarda bu yöntemin daha uygun olduğu konusunda kanaat oluşturmaktır. YÖNTEM ve GEREÇLER: Hastanemiz genel cerrahi kliniğinde haziran 2015 ve haziran 2018 tarihleri arasında band ligasyonu yapılan ve takibebe gelen hastalar dahil edildi. Hasta cinsiyeti, yaşı, BMI, şikayet süresi, tedavi süresi, hemoroidin evresi, işlem tarihi, takip süresi, tekrar bandlama yapılması, muayane bulguları, komplikasyonlar, kabızlık skoru ve hasta memnuniyeti parametrelerine bakıldı. BULGULAR: Çalışmaya 80 erkek (%75,5) ve 26 kadın (%24,5) olmak üzere toplam 106 hasta alınmıştır. Ortalama takip süresi 29,9±13,5 ay, hastaların yaş ortalaması 44,2±12,5 ve BMI ortalaması 29,2±4,7 dir. Ortalama şikâyet süresi 8,9±7,6 yıldır. Tedavi süresi ortalama 6,5±6,2 aydır. Hastalardan 49 (%47,1) unda grade 2, 55 (%52,9) inda grade 3 hemoroid tespit edildi. Nüks olan hastalar incelendiğinde hemoroidin derecesi, kabızlık skoru ve anal tonus artışının nükste anlamlı derecede etkili olduğu bulundu. Ayrıca kabızlık skoru yüksek olan veya anal tonusu yüksek olan hastalarda memnuniyet oranları anlamlı derecede düşük bulundu. TARTIŞMA ve SONUÇ: Band ligasyonu kolay uygulanabilir, başarılı ve güvenli bir yöntemdir. Ancak bütün hastalar için ilk seçenek olmayabilir. Bazı hasta gruplarında başarıyı etkileyen faktörlerin tespiti durumunda tedavide alternatif ofis prosedürü seçenekleri düşünülebilir.

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1. Thomson W. The nature of haemorrhoids. British Journal of Surgery. 1975;62(7):542-52.

2. Ratan R, Rao P. Rubber Band Ligation in Early Stage Hemorrhoids: Outcome & Efficacy in Today’s Era. International J of Healthcare and Biomedical Research. 2018;6(02):66-72.

3. Beeley N, Berger A. How to treat haemorrhoids. BMJ. 2000;321:582-3.

4. Loder P, Kamm M, Nicholls R, Phillips R. Haemorrhoids: pathology, pathophysiology and aetiology. British Journal of Surgery. 1994;81(7):946-54.

5. Smith LE. Hemorrhoids. A review of current techniques and management. Gastroenterology Clinics of North America. 1987;16(1):79-91.

6. Davis BR, Lee-Kong SA, Migaly J, Feingold DL, Steele SR. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of hemorrhoids. Diseases of the Colon & Rectum. 2018;61(3):284-92.

7. Blaisdell PC. Office ligation of internal hemorrhoids. The American Journal of Surgery. 1958;96(3):401-4.

8. Barron J. Office ligation of internal hemorrhoids. The American Journal of Surgery. 1963;105(4):563-70.

9. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatments: a meta-analysis. Canadian Journal of Surgery. 1997;40(1):14.

10.Agachan F, Chen T, Pfeifer J, Reissman P, Wexner SD. A constipation scoring system to simplify evaluation and management of constipated patients. Diseases of the colon & rectum. 1996;39(6):681-5.

11.Iyer V, Shrier I, Gordon P. Long-term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Diseases of the colon & rectum. 2004;47(9):1364-70.

12.Gagloo MA, Hijaz SW, Nasir SA, Reyaz A, Bakshi I, Chowdary NA, et al. Comparative study of hemorrhoidectomy and rubber band ligation in treatment of second and third degree hemorrhoids in Kashmir. Indian Journal of Surgery. 2013;75(5):356- 60.

13.Filingeri V, Angelico R, Bellini M, Manuelli M, Sforza D. Prospective randomised comparison of rubber band ligation (RBL) and combined hemorrhoidal radiocoagulation (CHR). Pain. 2012;46:51.1.

14.Savioz D, Roche B, Glauser T, Dobrinov A, Ludwig C, Marti M-C. Rubber band ligation of hemorrhoids: relapse as a function of time. International journal of colorectal disease. 1998;13(4):154-6.

15.Komborozos VA, Skrekas GJ, Pissiotis CA. Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases. Digestive surgery. 2000;17(1):71-6.

16.El Nakeeb AM, Fikry AA, Omar WH, Fouda EM, El Metwally TA, Ghazy HE, et al. Rubber band ligation for 750 cases of symptomatic hemorrhoids out of 2200 cases. World Journal of Gastroenterology: WJG. 2008;14(42):6525.

17.Lu L, Zhu Y, Sun Q. A retrospective analysis of short and long term efficacy of RBL for hemorrhoids. Age (mean, range). 2013;46:16-88.

18.Nikam V, Deshpande A, Chandorkar I, Sahoo S. A prospective study of efficacy and safety of rubber band ligation in the treatment of Grade II and III hemorrhoids–a western Indian experience. Journal of Coloproctology. 2018.

19.Bayer I, Myslovaty B, Picovsky B. Rubber band ligation of hemorrhoids: convenient and economic treatment. Journal of clinical gastroenterology. 1996;23(1):50-2.

20.Wechter DG, Luna GK. An unusual complication of rubber band ligation of hemorrhoids. Diseases of the colon & rectum. 1987;30(2):137-40.

21.Bat L, Melzer E, Koler M, Dreznick Z, Shemesh E. Complications of rubber band ligation of symptomatic internal hemorrhoids. Diseases of the colon & rectum. 1993;36(3):287-90.

22.Bhimani JV, Nair RR, Leuva HL. Comparative study between scerotherapy and rubber band ligation in haemorrhoids. İnternational journal of scientific research. 2018;7(1).