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Hundred
previously untreated out patients with first and second degree haemorrhoids
were subjected to either rubber band ligation (n=55) or injection sclerotherapy
(n=45). Follow-up was maintained over a period of 60 days at specific
intervals in twenty-eight patients of rubber band ligation (group I)
and twenty-seven patients of injection sclerotherapy (group II). Rubber
band ligation proved to have a satisfactory outcome in terms of bleeding
(P > 0.0001) than injection sclerotherapy. In terms of recurrence,
there was less recurrence in group I than group II. The relative risk
of recurrence in group II as compared to group I, calculated by computing
odd’s ratio is 1.58 (95% confidence interval being 0.33-7.73),
although the difference in recurrence is not statistically significant.
Both methods were equally effective in terms of pain and discomfort.
The number of sittings required did not differ significantly between
the two methods. The cost of treatment in group II is 7-10 times more
than those of group I (Table 1).
Pile banding is a simple, safe and out patient method with few mishaps
and side effects for the treatment of first and second degree haemorrhoids. |
| |
| INTRODUCTION |
The
subject of haemorrhoids is old and various modalities of treatment are
available for the same. The basic principle of treatment is ligation,
cautery, and excision. Out patient department procedure for first and
second degree haemorrhoids are likely to be successful in 90% cases.1
This study was based on symptomatic relief of patients following the
different modalities. |
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| MATERIAL
AND METHODS |
Hundred
patients with first and second degree haemorrhoids were chosen for rubber
band ligation (n=55) and injection sclerotherapy (n=45). The subjective
response in terms of bleeding, discharge and discomfort was noted, over
a period of one month.
The groups were comparable with respect to age, sex and duration of
symptoms. Fifty-five patients were subjected to banding with Barron’s
apparatus. Forty-five patients were subjected to injection sclerotherapy
with a Gabriel syringe, 3% sodium Tetradecyl Sulphate was used as a
sclerosant.
Patients were reviewed on 3rd, 7th, 15th, 30th and 60th day. The residual
symptoms were subjectively ranked. Proctoscopy was performed and efficacy
of treatment noted.
tatistical analysis was done by Chi-square test with Yates correction
wherever necessary and estimation of relative risk by odd’s ratio.
Odd’s ratio : 1.56
Confidence : 95% interval (0.33 < or < 7.73)
Chi-square : 0.09
P < 0.05 (not significant)
The number of sittings required by the patients did not differ in the
two groups. At the end of one month, the subjective response was excellent
in 23 (54%) patients in group I as compared to 15 (38%) in group II.
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|
RESULTS |
 |
Follow-up
was obtained for a period of 60 days. The presenting symptoms
in both the groups were bleeding in 47 (87%) of group I and
39 (86%) patients of group II, discomfort was present in 34
(62%) patients of group I and 23 (53%) of group II, while discharge
was seen in 29 (54%) of group I and 20 (44%) of group II. At
day 30 it was observed that bleeding persisted in 7 (15%) of
group I and 15 (38%) of group II. Similarly patients with discomfort
were 5 (11%) in group I and 6 (15%) in group II and patients
with discharge were 23 (54%) in group I and 14 (36%) in group
II. Symptomatically there was minimal improvement in both groups.
This was not statistically significant. |
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| DISCUSSION |
Despite the freedom
from piles, haemorrhoidectomy is a painful procedure and has its complication
like bleeding, stenosis and incontinence.2 Rubber band ligation as
an office procedure was started way back by Barron.3 The use of rubber
band with internal diameter 1/16th of an inch gives adequate compression
till sloughing of the pile mass occurred. Rubber band ligation has
also been tried for prolapsed piles but pain, pruritus ani or faecal
soiling was not taken into consideration.4
Rubber band ligation is an effective method for the treating symptoms
due to haemorrhoids with undoubted economic advantage over injection
sclerotherapy.
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| ACKNOWLEDGEMENT |
We
are thankful to Dr. Daniel, Professor and Head of Department of Preventive
and Social Medicine, BYL Nair Ch. Hospital, for helping
us in statistical analysis. |
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| REFERENCES |
| 1. |
Murie
JA, Sim AJW. Mackenzie I. Rubber band ligation versus Haemorrhoidectomy
for prolapsing Haemorrhoids - a long term prospective trial.
Br J Surg 1982; 69 : 536-38. |
| 2. |
Goligher
JC. Surgery of Anus, Rectum and Colon. 2nd ed. London, Balliere
Tindall and Cassell 1967; Ch. 4 : 155. |
| 3. |
Barron
J. Office ligation of internal Haemorrhoids. AJS 1963; 105 :
563-68. |
| 4. |
Templeton
JL, et al. Comparison of infrared coagulation and rubber band
ligation for first and second degree haemorrhoids - a randomized
clinical trial. BMJ 1983; 286 : 1387-89. |
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