Rubber band ligation (RBL) for haemorrhoids. The experience of three surgical units

Abstract

Haemorrhoids are the most common proctological disorder with a high incidence per year and a prevalence up to 39% in the general population 1 . This condition often leads to disruption in an individual’s personal and working life.

Management has considerable cost implications, and therefore, economic consequences 2 .

Due to the fear of SARS-COVID infection the most of patients actually regret hospitalization for surgery and choose to delay the time of treatment. RBL can be proposed as successful procedure to patients with II-III grade with a short stay in the hospital. Treatment consists initially of conservative measures such as lifestyle advice, diet and toilet behaviour.

When conservative hemorrhoid therapy is ineffective, many physicians may choose other non-surgical modalities: rubber band ligation, injection sclerotherapy, cryotherapy, manual dilation of the anus infrared photocoagulation, bipolar diathermy 3 , direct current electrocoagulation 4 . Rubber band ligation (RBL) was established as one of the most important, cost-effective and commonly used treatments for first- to third-degree internal hemorrhoids. It is a very effective non-surgical treatment for internal hemorrhoids. causing fibrosis, retraction, and fixation of the hemorrhoidal cushions.

Rubber band ligation is also more effective than sclerotherapy and infra-red coagulation, but more painful. Overall complications occur in less than 10%. A retrospective study of 186 patients outpatients who underwent RBL with a minimum follow-up of 12 months is reported. Results confirmed it is effective until 1 year with a low rate of complications and could be offered as conservative treatment for I to III grade hemorrhoids.