Rubber band ligation vs injection sclerotherapy in office management of 1st and 2nd degree hemorrhoids

ABSTRACT

To compare the effectiveness and complications of Rubber Band Ligation [RBL] with Injection Sclerotherapy [IST] in the treatment of 1st degree and 2nd degree hemorrhoids. Randomized Controlled Trial. CMH Rawalpindi, from 1st Feb to 30 Sep 2007. A total of 120 patients were selected for study. 60 patients with 1st degree haemorrhoids were placed in group I and 60 patients with 2nd degree haemorrhoids were placed in group II. These patients were then randomly divided into two sub-groups 'A' and 'B' through Random Allocation by Table of Random Numbers. Group 'IA' had 30 patients of 1st degree haemorrhoids and group 'IIA' had 30 patients of 2nd degree haemorrhoids. Similarly group 'IB' had 30 patients of 1st degree haemorrhoids and group 'IIB' had 30 patients of 2nd degree haemorrhoids. Then groups 'IA' and 'IIA' were subjected to RBL and Groups 'IB' and 'IIB' were subjected to IST. The outcome measures were relief of symptoms, recurrence rate and complications. Male to female ratio was 111. Among patients subjected to RBL, 58.3% were from age group 2 [31-50 yrs] with mean age 42.90 +/- 11.74 yrs and mean duration of symptoms was 6.24 + 4.91 months. Among patients subjected to IST, 55% were from age group 2 [31-50 yrs] with mean age 45.62 +/- 12.49 yrs and mean duration of symptoms was 7.03 + 4.76 months. Important immediate complication was pain, but majority of patient were pain free. In group IA 36.7% patients had slippage of ligature but none of the patients undergoing IST developed Prostatitis. Visible bleeding was the main complication in group 'IA' 4th week [p < 0.05]. Response to IST among 1st degree haemorrhoids was significant at 4th week i.e. 90%, as compared to RBL, i.e. 63.3% [p <0.05]. IST is treatment of choice for 1st degree haemorrhoids, but for 2nd degree haemorrhoids, both RBL and IST are equally effective