Development of a low-cost simulator for training in hemorrhoidal ligation

Introduction: Rubber band ligation is a minimally invasive outpatient hemorrhoid treatment with low cost, low complication rates, and rapid realization. It is performed with the aid of an anoscope and uses a rubber ring that surrounds the hemorrhoidal nipple, causing compression of the vascular structures of the tissue, leading to necrosis and remission of the hemorrhoid. No device for training this essential procedure for treating this pathology has been identified in the literature. Therefore, we aim to develop a low-cost simulator for training hemorrhoidal rubber ligation. Methods: The model was constructed using PVC pipe wrapped in neoprene fabric. Hemorrhoidal nipples and the pectineal line were also simulated using fabric and sewing threads. The procedure is performed with conventional anoscope and ligature forceps. Conclusion: The device in question is a low-cost simulation model designed to train the skills required to perform a rubber band ligation and review the basic anatomy of the anal canal during anoscopy. Given these qualities, the model can be used for academic training due to its low cost and simplicity of application. (AU)

A prospective clinical study of endoscopic foam sclerotherapy combined with rubber band ligation in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids (with video) / 中华消化内镜杂志

Objective:To evaluate the safety and long-term effectiveness of endoscopic foam sclerotherapy (FS) combined with endoscopic rubber band ligation (ERBL)in the treatment of grade Ⅱ-Ⅲ internal hemorrhoids.Methods:Consecutive patients diagnosed as having grade Ⅱ-Ⅲ internal hemorrhoids in Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January to December 2020 were prospectively enrolled in the study, and randomly divided into ERBL group and FS combined with ERBL group. The 24 h visual analogue scale (VAS) for pain and 1-week degree of bleeding were evaluated after the treatment. After follow-up of 6 months, the effectiveness of treatment was evaluated.Results:A total of 84 patients with age of 54.4±7.9 years were enrolled, 57.1% (48/84) males, and 73.8% (62/84)grade Ⅱ internal hemorrhoids. Forty-three patients were assigned to the ERBL group and 41 to the FS combined with ERBL group. There was no significant difference between the two groups in baseline data ( P>0.05). In the FS combined with ERBL group, the mean amount of polidocanol foam was 13.8±2.5 mL, the mean number of injection site was 4.7±1.2, and the median scores of VAS was 0 (0, 3), which was significantly lower than that of ERBL group [2 (0, 4), Z=-2.116, P=0.034]. The bleeding rate 1 week after treatment in the ERBL and FS combined with ERBL group were 20.9% (9/43) and 29.3% (12/41), respectively, and mild bleeding was the main symptom. There was no significant difference between the two groups in the bleeding degree ( U=807.0, P=0.378). After 6 months of follow-up, the total effective rates in the ERBL group and the FS combined with ERBL group were 81.4% (35/43) and 90.2% (37/41), respectively ( U=684.5, P=0.044). Conclusion:FS combined with ERBL can effectively relieve post-treatment perianal pain, and improve the long-term effectiveness.

Sangrado tardío luego de tratamiento con macroligadura elástica de hemorroides / Late bleeding after hemorrhoid treatment with rubber macroband ligation

Objetivo: Presentar el caso infrecuente de sangrado tardío posterior al tratamiento con macroligadura elástica de hemorroides, tratamiento propuesto por A. Reis Neto. Caso Clínico: Mujer de 26 años con tratamiento de hemorroides con macroligadura elástica. A los 28 días es admitida en urgencia por proctorragia abundante sin signos de shock hipovolémico. Laboratorio: Hematocrito 27%, Hemoglobina 8,9 mg/dl. Se realiza colonoscopia evidenciando la cicatriz de macroligadura con signos de coágulo desprendido sin sangrado activo. Se decide conducta expectante con tratamiento de la hipovolemia incial y anemia. Evoluciona sin resangrado con control endoscópico a los 60 y 180 (sin sangrado y excelentes resultados). Discusión: La macroligadura es una técnica alternativa para el tratamiento de hemorroides con excelentes resultados anatómicos y funcionales. Presenta menor dolor postoperatorio, bajo índice de complicaciones (ninguna severa o propia del método). No existen comunicaciones sobre sangrado tardío grave tanto en ligaduras convencionales como macroligadura. Conclusiones: Se presenta el primer caso comunicado a la fecha de un sangrado tardío en macroligaduras que fue resuelto en forma conservadora.

Objetive: To present an infrequent clinical report of a case of late bleeding after rubber macroband ligation. Case report: A 28-year-old female with severe rectal bleeding but no associated shock was presented 28 days after rubber macroband ligation at emergency room. Blood samples showed acute anemia. An urgent colonoscopy was performed which showed a scar without acute bleeding. Medical treatment was settled. There was no secondary bleeding in follow up. Endoscopic control was done at 60 and 180 days. Discusion: Hemorrhoidal rubber macroband ligation is a modification of conventional rubber band ligation. It was proposed and developed by J.A. Reis Neto (Campinas, SP, Brazil). Morbidity is low and results are excellent. There is no previous report of delayed bleeding considering both rubber band and macroband ligation. Conclusion: The First case of late bleeding after rubber band ligation treated with conservative measures.

Macroligaduras hemorroidales. Tratamiento ideal del prolapso hemorroidario. Seguimiento a 5 años / Hemorrhoidal macro rubber band ligations. Ideal treatment of hemorrhoidal prolapse. Follow-up at 5 years

Introducción: Entre los tratamientos alternativos de las hemorroides se destaca por ser costo-eficientes las ligaduras elásticas convencionales. Las macroligaduras elásticas se hayan en difusión por similares resultados que las bandas elasticas convencionales. La literatura es aun escasa. El objetivo fue analizar los resultados, morbilidad y recidiva a corto y mediano plazo de hemorroides tratadas con macroligaduras. Diseño: Estudio observacional analítico prospectivo. Pacientes: 188 pacientes (110 varones y 78 mujeres). Periodo: 2011-2014. Lugar: Institución privada universitaria. Métodos: Inclusión: pacientes tratados con hemorroides internas sintomáticas. Exclusión: enfermedad anoperineal asociada, tratamiento previo, inmunocompromiso o anticoagulación. Se registraron resultados, complicaciones y recidiva. La técnica empleada fue la descripta por Reis Neto. El Seguimiento fue a 10, 30 días y 6 y 12 meses y 5 años. Resultados: Todos fueron tratados con internación de corta estadía. La edad fue 49,5 años (23-76). Los síntomas fueron prolapso 96, sangrado 44 y ambos 48. Se realizó sólo una sesión en 178 casos (94,6%). Se trataron 2 paquetes en 122 y 3 en 66. El dolor moderado fue en 5 casos y prolongado en 2. El sangrado leve y tenesmo se presentó en la mayoría de los pacientes, pero desapareció en la primera semana. Se registró sangrado inmediato moderado en 5% sin sangrado severo inmediato. Otras complicaciones inmediatas: 2 trombosis y 3 congestión/edema local. En 1 paciente ocurrió un sangrado que requirió de internación sin necesidad de cirugía en forma alejada. Sólo en 3 casos se realizó resección local de plicomas previos. En 139 casos se realizó como único procedimiento. La recidiva fue 6 casos. (2 al primer año y 4 a los 5 años), 5 se trataron con nueva macroligadura y 1 con cirugía. No se registró ninguna complicacion severa, infecciosa o única relacionada al procedimiento. El seguimiento a 1 año fue del 100% y a 5 años del 96%. Discusión y conclusiones: El tratamiento con macroligaduras para el prolapso hemorroidario presentó con baja morbilidad sin complicaciones severas. Los resultados son reproducibles entre diferentes autores. Son el tratamiento ideal para las hemorroides grado III con poco componente externo. (AU)

Introduction: Alternative therapies for internal hemorrhoid plexus are several procedures with specific indications for each grade of hemorrhoid. Due to some major advantages, rubber band ligation has become probably in the most popular between colorectal surgeons. The high-macro rubber band ligation appears to be as the first choice but literature is few. Objective: To analyze results, morbidity and recurrence of internal hemorrhoid disease treated with high-macro rubber band ligation. Design: Observational non-randomized prospective analysis. Patients: 188 patients (110 male). Period: 2011-2014. Setting: Private Institution. Methods: Patients with symptomatic internal hemorrhoid disease (grade II-III-IV). Results, Immediate and late complications and 5 years recurrence were registered. Technique used was the original description by Reis Neto. Patients with immunosuppression, additional perianal disease, previous treatment and anticoagulation were excluded. Results: There was only one session in 178 cases. Two banding were placed in 122 and 3 in 66. Symptoms were prolapse in 96, bleeding in 44 and both in 48. 139 patients were treated as only procedure. Tenesmus and light hemorrhage occurred in most cases. Moderate or late pain was registered in 7 cases, and immediate moderate bleeding in 5%. There was no severe immediate bleeding. Immediate morbidity was 2 thrombosis and 3 anal congestion. There was one moderate late bleeding at day 28 and required admission. Recurrence occurred in six cases, 5 were ligated again and 1 was treated by conventional surgery. There was none severed or unique complication or infection associated. Discussion and conclusion: Macrorubber band presented low morbidity and there are no severe complications at 5 years follow-up. Recurrence of prolapse is low and could be treated by a new session with equal morbidity. Results are equivalent and reproducible by different authors. This procedure might be the ideal treatment for hemorrhoid prolapse. (AU)

Rubber band ligation of hemorrhoids: a hospital based study

Background: Hemorrhoids are symptomatic anal cushions containing arteriovenous anastomosis. Patient with haemorrhoids can present as bleeding per rectum, something (mass) coming out per rectum, perianal itching, Anaemia due to occult blood loss. Various modalities of treatment have been developed to treat symptomatic haemorrhoids. This study was undertaken to determine the efficacy of rubber band ligation in the management of haemorrhoids.Methods: This study was a prospective study conducted in the Department of Surgery, Government Medical College, Srinagar from June 2015 to June 2018. Patients at any age with first, second- or third-degree internal haemorrhoids were included in the study. Patients with fourth degree, complicated haemorrhoids, previous anorectal surgery or anorectal pathology, and chronic liver disease were excluded. A total of 212 patients were included in the study. Rubber band ligation was done as an OPD procedure. The patients were followed at 2 weeks, 4 weeks, 3-month, 6 month and 1 year after the procedure.Results: In this study, out of 212 patients, 154(72.6%) were males and 58(27.4%) females. The mean age of this study was 38.7 yr. (Range 17-73 yr.). Patients presented with the complaints of bleeding (184, 86.8%), prolapse (114, 53.7%), constipation (116, 54.7%), priuritis ani (36, 17.0%), pain (12, 5.6%). Band ligation was successful in 188(88.8%) patients, 169(79.7%) patients were cured and in 19(8.9%) improvement was obtained. Various complications occurred after band ligation including vasovagal syncope (2, 0.9%), bleeding per anum (6, 2.8%), pain (12, 5.6%), fissure in ano (1, 0.5%). Recurrence after one year was seen in 9(4.2%) patients.Conclusions: Author concluded in this study that RBL is an effective outpatient treatment for grade II and III internal haemorrhoids without much complications.

Hemorrhoidectomy versus rubber band ligation in treatment of second and third degree hemorrhoids: a comparative study

Background: Optimum surgical intervention for low-grade haemorrhoids is unknown. Haemorrhoidal artery ligation (HAL) has been proposed as an efficacious, safe therapy while rubber band ligation (RBL) is a commonly used Out patient treatment.Methods: We compared recurrence after HAL versus RBL in patients with grade II-III haemorrhoids. The diagnosis of hemorrhoids is primarily based on the proctoscopic  examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1 year from January 2017 to December 2017. It includes 50 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of Tertiary Care Hospital in Gujarat. These 50 patients were selected randomly and divided into two groups of 25 patients each (hemorrhoidectomy group and RBL group). Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed.Results: Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery.Conclusions: RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.

Macroligadura como tratamiento para hemorroides / Macro-ligation as a hemorrhoid treatment

Introducción: Las hemorroides constituyen una dilatación varicosa de los plexos hemorroidales que involucran la mucosa del recto y ano. Estas constituyen la enfermedad anorrectal más frecuente en el mundo occidental, con una alta prevalencia que suele representar el 50 % de las consultas con el proctólogo. Se pueden describir dos grandes grupos de hemorroides, los internos que son aquellos situados por encima de la línea pectínea y los externos que son los que se encuentran por debajo de esta línea, se tendrán en cuenta los internos. A estos últimos se los clasifica por Goligher en relación con el grado de prolapso de la mucosa rectal y la posibilidad de reducción del prolapso. Para las hemorroides grado II y III se han diseñados diferentes métodos quirúrgicos de tratamiento desde la electrocoagulación, la crioterapia, la terapia fotodinámica y RBL El presente trabajo plantea como objetivo describir nuestros resultados iniciales en el tratamiento de patología hemorroidal por medio de la técnica de macroligadura alta por aspiración RBL. Materiales y Métodos: Se incluyeron 40 pacientes a los que se le realizo RBL, comprendidos desde el mes de octubre de 2016 a marzo de 2018, que presenten patología hemorroidal grado II III y IV, técnica de macroligadura alta por succión. Resultados: Del 63% de femenino y un 37% de masculino, la distribución por grados fue de la siguiente manera, grado 2: 75%, grado 3: 17.5% y grado 4: 7.5%, el dolor posterior al procedimiento en forma inmediata fue de 3.78±2.63, a las 48 hs 2.10±2.31 y a los 7 postquirúrgicos 1.10±1.86. Tuvimos un total de 7 (18%) pacientes con recidivas dentro de los 18 meses de seguimiento, tenesmo se presentó 27.59% en los grados 2, un 57,14% en los grados 3 y un 66,67% en los grados 4. Solo reportamos un 23% de sangrado posquirúrgico. Conclusión: Podemos afirmar que la técnica de macro ligadura alta como variante de la RBL, es una técnica segura, aplicable en forma ambulatoria, con un beneficio importante por sobre el resto de las técnicas resectivas que solo requiere una sedación para el procedimiento, con bajos umbrales de dolor postquirúrgicos, pronta recuperación y reinserción laboral; presenta bajos índices de complicaciones. Además, representa una excelente opción para el tratamiento de las hemorroides grado 2 y 3. (AU)

Introduction: Hemorrhoids are a varicose dilatation of the hemorrhoidal plexuses that involve the mucosa of the rectum and anus. These constitute the most frequent anorectal disease in the western world, with a high prevalence that usually represents 50% of consultations with the proctologist. Two large groups of hemorrhoids can be described; the internal ones that are those located above the pectineal line and the external ones that are those below this line, the internal ones will be taken into account. The latter are classified by Goligher in relation to the degree of prolapse of the rectal mucosa and the possibility of prolapse reduction. For the grade II and III hemorrhoids, different surgical methods of treatment have been designed from electrocoagulation, cryotherapy, photodynamic therapy and RBL. The present work aims to describe our initial results in the treatment of hemorrhoidal pathology by means of the macro-adherence technique. High by RBL aspiration. Materials and Methods: Forty patients were included, who underwent RBL, from October 2016 to March 2018, who presented grade II III and IV hemorrhoidal pathology, high suction macroligation technique. Results: Of 63% of female and 37% of male, the distribution by grades was as follows, grade 2: 75%, grade 3: 17.5% and grade 4: 7.5%, pain after the procedure immediately it was 3.78 ± 2.63, at 48 hours 2.10 ± 2.31 and at 7 postsurgical 1.10 ± 1.86. We had 7 (18%) patients with recurrences within 18 months of follow-up; tenesmo presented 27.59% in grades 2, 57.14% in grades 3 and 66.67% in grades 4. We only reported 23% of postoperative bleeding. Conclusion: We can affirm that the high macro ligature technique as a variant of the RBL is a safe technique, applicable in ambulatory form, with an important benefit over the rest of the resection techniques that only requires a sedation for the procedure, with low postoperative pain thresholds, early recovery and re-employment; It presents low rates of complications. In addition, it represents an excellent option for the treatment of grade 2 and 3 hemorrhoids. (AU)

Complicaciones infecciosas graves luego de la ligadura con banda elástica para hemorroides: reporte de un caso y revisión de la literatura / Acute infectious complications after ligation with elastic band for hemorrhoids: a case report and literature review

Introducción: La ligadura con banda elástica es un procedimiento efectivo y de bajo costo, para el manejo de hemorroides grado I-III, que no requiere internación. Sus complicaciones, cuando presentes, son habitualmente leves. Aunque poco comunes, existen complicaciones graves asociadas a este procedimiento. El objetivo de este estudio es realizar una revisión de las complicaciones infecciosas pelvi-perineales de la ligadura con banda elástica, características comunes de presentación y alternativas de tratamiento en aquellos que sufren estas complicaciones. Descripción del caso: Se expone el caso de un hombre de 71 años de edad que presentó una sepsis pelviana severa posterior a la realización de una ligadura con banda elástica. A las 48 horas del procedimiento consulta por dolor perianal, dificultad miccional y fiebre. Se realiza el drenaje quirúrgico de ambas fosas isquiorrectales, luego de lo cual intercurre con shock séptico, realizándose una laparotomía, drenaje de retroperitoneo, colostomía sigmoidea. Posteriormente, debido al desarrollo de un síndrome compartimental abdominal, el abdomen se dejó abierto y contenido con una malla. Discusión: Se han descripto complicaciones sépticas posteriores a escleroterapia y crioterapia hemorroidal, ligadura con banda elástica, hemorroidectomia convencional y con sutura mecánica. Se exponen 20 casos de sepsis pelviana post-ligadura con banda elástica. La relación hombre:mujer fue de 3:1, con un amplio rango de edad (27-82 años). Sólo 2 tenían antecedentes de inmunosupresión. La progresión o la persistencia del dolor asociado a fiebre, dificultad miccional, edema perineal y/o genital fueron signos y síntomas comunes que se manifestaron dentro de los 14 días posteriores a la ligadura. Tal como en el caso aquí referido como en otros ya publicados, la realización de imágenes ayudó al diagnóstico y a la planificación quirúrgica. Todos recibieron antibioticoterapia de amplio espectro y 13 requirieron además cirugía. El espectro de tratamientos quirúrgicos fue desde el drenaje incisional hasta la amputación rectal. Ante la progresión del cuadro séptico, la realización de una ostomía fue la conducta más usual. Cinco pacientes requirieron más de una cirugía, y 8 fallecieron. Conclusión: Es importante conocer las complicaciones infecciosas mayores y su presentación clínica, para realizar un diagnóstico y tratamiento precoz de las mismas, con el fin de disminuir su elevada morbilidad o mortalidad. (AU)

Background: Rubber band ligation is an effective, low-cost procedure for grade I-III hemorrhoids, and does not require hospitalization. Its complications, when present, are usually mild. Although rare, there are serious complications associated with this procedure. The purpose of this review was to identify common presenting features and treatment alternatives in those who suffer pelviperineal infectious complications after rubber band ligation. Case Report: The present case is that of a 71-year-old man who presented severe pelvic sepsis after rubber band ligation. He complained of perianal pain, voiding difficulties and fever 48 hours after the procedure. Surgical drainage of both ischiorectal fossae was carried out. He developed septic shock. Laparotomy, retroperitoneal drainage and sigmoid loop colostomy were performed. In a subsequent operation due to abdominal compartment syndrome, the abdomen was left open and contained with a mesh. Discussion: Septic complications have been described after sclerotherapy, cryotherapy, rubber band ligation, conventional hemorrhoidectomy and stapled haemorrhoidopexy. We describe 20 cases of pelvic sepsis after rubber band ligation. The male: female ratio was 3: 1, with a wide age range (27- 82 years). Only 2 had a history of immunosuppression. The progression or persistence of pain associated with fever, voiding difficulties, perineal and / or genital edema were common signs and symptoms that appeared within 14 days after rubber band ligation. In the case here referred to as in others already published, imaging studies helped the diagnosis and surgical planning. All received broad spectrum antibiotic therapy and 13 required surgery. The spectrum of surgical treatments ranged from incisional drainage to rectal amputation. In view of the progression of the septic condition, performing an ostomy was the most usual conduct. Five patients required more than one surgery, and 8 died. Conclusion: It is important to acknowledge the major infectious complications and their clinical presentation, to help with an early diagnosis and treatment, in order to reduce their high morbidity and mortality. (AU)

A comparative study of rubber band ligation and flavonoids (Daflon) in the treatment of haemorrhoids.

Background: Haemorrhoids is a common disease affecting people of all ages and both sexes. Though there is no confusion on the treatment of 3rd and 4th degree haemorrhoids, there is still confusion regarding the ideal treatment for 1st and 2nd degree haemorrhoids. Aims & Objective: To compare the safety, efficacy, advantages and disadvantages of Rubber Band Ligation and Micronized Flavonoids in the treatment of internal haemorrhoids. Material and Methods: Two hundred patients of haemorrhoids were treated, One hundred cases with Rubber Band Ligation and rest hundred with Daflon 500 mg. The outcome measured in term of relief from bleeding and duration of treatment. Results: 82% of patients on Daflon and 60% of patients undergoing Rubber Band Ligation were completely cured (P<0.01) on the 7th day but on follow up there is no statistical significance. Conclusion: Daflon gives rapid relief from symptoms of haemorrhoids as compared to Rubber Band Ligation but the long duration and higher cost of treatment patient acceptability and compliance is less.

Várices gástricas: un reto para el manejo endoscópico / Gastric varices: a challenge for endoscopic management

La hemorragia de vías digestivas altas por várices gástricas, aunque menos frecuente que la secundaria a lasesofágicas, es una causa de alta mortalidad en los pacientes cirróticos. La ligadura es el tratamiento óptimoen las várices esofágicas, pero este tratamiento para las gástricas es todavía muy discutido.Presentamos el caso de una anciana, con antecedente de cirrosis hepática secundaria a esteatosis hepáticano alcohólica (NASH), que ingresa, con hemorragia de vías digestivas altas, evidenciándose en laesofagogastroduodenoscopia una várice fúndica subcardial con sangrado activo, para la cual se decide manejocon ligadura con banda de caucho con resultado exitoso y desaparición de la várice en control posterior

Upper digestive tract bleeding due to gastric varices, although less common than bleeding secondary toesophageal varices, is one of the causes of high mortality in cirrhotic patients. Although band ligation is theoptimal treatment for esophageal varices, its use for gastric varices is still hotly debated.We report the case of an elderly woman with a history of hepatic cirrhosis secondary to nonalcoholicsteatohepatitis (NASH) and obesity who was admitted to the hospital with upper digestive tract bleeding.An esophagogastroduodenoscopy showed an actively bleeding subcardial varice in the gastric fundus. Thedecision was made to manage the bleeding with rubber band ligation. The outcome was successful outcome,and the varice had disappeared in subsequent check-ups

Tratamento da doença hemorroidária com ligadura elástica: estudo prospectivo com 59 pacientes / Rubber band ligation for the treatment of hemorrhoidal disease: prospective study with 59 patients

A ligadura elástica (LE) é considerada um método minimamente invasivo para o tratamento da doença hemorroidária (DH) e apresenta vantagens em relação à hemorroidectomia, como: simplicidade de execução e realização ambulatorial sem o emprego de anestesia. Trata-se de um método eficaz, principalmente nos portadores de DH grau II. Porém, apresenta complicações, sendo as mais frequentes: dor, tenesmo, hematoquezia e retenção urinária. Alguns trabalhos mostram complicações mais graves, como sangramentos vultosos que necessitaram de hemotransfusão. Assim, este trabalho avaliou a eficácia e a morbidade do tratamento da DH pelo método da LE. Foi um estudo prospectivo, com 59 pacientes. Destes, cinco (8,5 por cento) eram portadores de DH grau I, 33 (55,9 por cento) de DH grau II e 21 (35,6 por cento) de DH grau III. Todos os pacientes foram submetidos pelo menos a duas sessões. Nas 135 sessões realizadas, encontramos: hematoquezia em 62 (45,9 por cento), dor intensa em 39 (28,9 por cento), sintomas vagais em 10 (7,4 por cento) e pseudoestrangulamento em um (0,7 por cento) sessão. A taxa de cura do prolapso hemorroidário entre os portadores de DH grau II foi de 87,9 por cento e entre aqueles com DH grau III, de 76,2 por cento. O tratamento da DH pelo método da ligadura elástica mostrou-se seguro e com boa taxa de cura.

Rubber band ligation (RB) is considered a minimally invasive method for the treatment of hemorrhoidal disease (HD) and has advantages in relation to hemorrhoidectomy whereby: simplicity of execution, outpatient realization and no need of anesthesia. It is an effective method, especially in the HD grade II. However, shows complications, and the most frequents are: anal pain, tenesmus, hematochezia and urinary retention. Some studies have shown severe complications as major bleeding that needs blood transfusion. Thus, this study evaluated the effectiveness and the morbidity of the treatment of HD by the method of RB. It was a prospective study with 59 patients. Five (8,5 percent) patients had HD graded in the first degree, 33 (55,9 percent) in the second degree and 21 (35,6 percent) in the third. All patients were submitted to at least two sessions. In the 135 sessions performed, we found: hematochezia in 62 (45.9 percent), severe pain in 39 (28.9 percent), vagal symptoms in 10 (7.4 percent) and pseudostrangulation in 1 (0.7 percent) session. The cure rate of hemorrhoidal prolapse among patients with HD grade II was 87.9 percent and among those with HD grade III, 76.2 percent. The treatment of HD by the method of RB proved to be safe and with good cure rate.

Comparitive Study of Multiple Versus Single Rubber Band Ligation for Internal Hemorrhoids

Rubber band ligation for hemorrhoids was used for treating 1500 consecutive patients affected by 2nd and 3rd degree hemorrhoids over a period of 3 years (1999-2001). The patients were divided into 2 groups: Group 1,710 patients treated by the method of "multiple ligations"(2 or 3) in a single session and Group II, 790 patients treated by the method of "single Ligation" at one time over the same period. Post procedural results were satisfactory in 82% patients in Group I and 90% patients in Group II. Complication observed in Group II were significantly lower than Group 1. Thus, we conclude that rubber band ligation is a better modality of treatment for internal hemorrhoids if it is made with one ligation at a time, repeating the procedure every 3 weeks.

Ligadura endoscópica de várices de esófago / Endoscopic ligation of oesophageal varices

La ligadura endoscópica de várices de esófago es una técnica desarrollada por Stiegmann y colaboradores para el tratamiento de las várices sangrantes de esófago, que ha demostrado ser tan efectiva como la esclerosis endoscópica, con menor incidencia de complicaciones. Diversos estudios han mostrado que la ligadura endoscópica de várices es una alternativa promisoria a la escleroterapía.

Endoscopic rubber band liglation of esophageal varices is a technique developed by Stiegmann and co-workers in an attempt to provide an endoscopic treatment for bleeding esophageal varices that isat least as effective as endoscopic sclero therapy, but has a lower incidence of complications. Several studies have shown that endoscopic rubber band ligation of esophageal varices is a promising alternative to scierotherapy.