Rubber-band ligation for hemorrhoids in a colorectal unit. A prospective study.

INTRODUCTION Nowadays the rubber band ligation technique is one of the most worldwide used and effective treatment of the hemorrhoidal disease. OBJECTIVES Our study has as a goal to analyze the success or failure of the rubber band ligation in hemorrhoids grade 1,2 and 3, to analyze their complications and to see if all symptomatic hemorrhoids should be treated with ligation at the first visit. PATIENTS AND METHOD A prospective and descriptive study was designed for patients who came to the Colorectal Unit with hemorrhoidal disease from September 1997 to December 2001. First, second and third degree patients were treated according to the classification of hemorrhoids of St. Mark's Hospital. The technique of ligation after Barron was applied. RESULTS From 261 patients with a mean age of 48.3 (range: 16-86), 181 (99 M/82 W) have been treated with Barron's method and 80 with rich fiber diet and water. Rectal bleeding was the most common symptom (91.16%). Anuscopy showed hemorrhoidal disease in all the cases. From 181 patients, 19.33% were hemorrhoids degree I, 51.93% degree II and 29.83% degree III. Two hundred and eighty-seven ligation sessions were done and the balance of ligations per patient was 2.45 and 1.5 rubber band per session. The 32% of the patients referred pain after ligation. A 13.81% of cases were operated due to persistent rectal bleeding or hemorrhoidal prolapse. CONCLUSIONS Symptomatic hemorrhoids degree I and II with a short clinical history should be treated initially with a rich fiber and water diet. The technique of Barron is an effective therapy to treat the hemorrhoids degree 1, 2 and in 74% of success in cases with degree 3.