SCLEROTHERAPY VERSUS RUBBER BAND LIGATION;

COMPARATIVE STUDY OF EFFICACY AND COMPLIANCE IN THE TREATMENT OF UNCOMPLICATED SECOND DEGREE HAEMORRHOIDS

Abstract

Objective: To compare the outcome of two different procedures of non operative treatment of uncomplicated second degree
hemorrhoids in terms of efficacy and patients compliance. Study Design: Prospective interventional. Controlled Phase II clinical trial. Setting
& Duration: Surgical Unit DHQ (Teaching) Hospital Rawalpindi from 10th September 2004 to 20th May 2006. Methodology: Regardless of
age and sex, first hundred patients attending the out patients department of surgical unit, DHQ( Teaching) Hospital , Rawalpindi with
uncomplicated second degree hemorrhoids after informed consent were enrolled in the trial. Patients were divided into two treatment groups
A&B with 50 patients in each by random draw sampling. Patients in Group A were subjected to injection sclerotherapy (SCL) whereas of Group
B, Rubber band ligation (RBL) was performed. Results: One hundred patients of mean age of 42.24 years with uncomplicated second degree
hemorrhoids with standard deviation of + 13.63 years were enrolled in this study. Out of total one hundred patients, 62 were male and 38 were
female. The major indications of treatment were bleeding per rectum and prolapse. Patients in Group A were subjected to Injection
sclerotherapy (SCL) and of Group B , Rubber band ligation (RBL) was performed. In Group A , 28 patients (56%) were symptoms free after 4-6
weeks with single session of SCL , 16 patients (32%) required additional second session at eight week and 6 patients (12%) required third
session at 12 weeks respectively due to persistence of symptoms. In Group B , 44 patients (88%) were symptom free after four weeks with
single session of RBL, while 6 patients (12%) required second session at 10 weeks to become symptom free. At 12 month follow-up 46 patients
(92%) remain symptomfree and 4 patients (8%) had recurrence of symptoms in Group A and rubber band ligation was performed. All the
patients of Group B (RBL) remained symptom free. (P value=0.041). Conclusions: Rubber band ligation is a safe, effective, economical non
operative treatment option for second degree uncomplicated hemorrhoids with good patients compliance.