Criteria for choice of an outpatient procedure for treatment of bleeding hemorrhoids

ABSTRACT

Although numerous non-operative treatments for management of hemorrhoids have been suggested, none has been reported to be superior to the others in control of bleeding due to hemorrhoids. In this study, three non-operative procedures were used in treatment of bleeding hemorrhoids in 118 patients. Sixty three patients were treated by infrared coagulation in a total of 110 sessions, 31 patients were treated by rubber band ligation in 53 sessions and 24 patients by injection sclerotherapy in 31 seasions. The efficacy of each procedure in controlling bleeding was correlated to the degree of hemorrhoids and severity of pre-treatment bleeding taking into consideration pain experienced during application of the technique, complications, recurrence rate and cost-effectiveness. Infrared coagulation has a total cure rate of 89.5% which was higher in patients with first- and second-degree hemorrhoids and lower in patients with severe bleeding regardless the degree of hemorrhoids. On the other hand, rubber band-ligation was superior to infrared coagulation in control of severe bleeding and in patients with third degree piles. Injection sclerotherapy had highest recurrence rate [20.8%] whatever was the degree of hemorrhoids and the severity of bleeding. These data, indicate that, except for those with interno-external hemorrhoids or associated anal fissure, all patients with bleeding hemorrhoids could be treated in the outpatient clinic and procedure should individualized according to the degree of hemorrhoids and severity of bleeding