Rehan Abbas Khan, Muhammad Iqbal, Farhan Zaheer, Khalid Ahsan Malik, Anisuz Zaman.
Rubber band ligation for the symptomatic hemorrhoids. what troubles the patient?.
Pak J Surg Jan ;28(4):266-70.

Introduction: Rubber band ligation is a simple out patient procedure routinely performed for symptomatic hemorrhoids. Th ough considered as a safe and eff ective procedure, studies show complications like recurrence, pain, bleeding and even pelvic sepsis in some cases. Th is study shares the local experience regarding the safety and effi cacy of this procedure for diff erent forms of hemorrhoids in our population. Material and method: Th is prospective observational study was performed during October 2009 to December 2011, in surgical outpatient department of Civil Hospital, Karachi which is a 1670-bed tertiary care teaching hospital. A total of 75 patients with the diagnosis of hemorrhoids were included in the study. Patients were asked to have an enema in morning on the day of RBL. No more than two sites were banded in a single sitt ing. Patients were followed up to 12 weeks for complications and recurrence. Results: Th e study consisted of seventy two male and three female patients. Mean age was 50.5 yrs. Painless bleeding per rectum during and aft er defecation was the presenting complaint in almost all (98.6%) patients, followed by hemorrhoidal prolapse (90.6%), perianal discharge (36%) and perianal itching (20%). Maximum number of patients had 2nd degree hemorrhoids (48%), followed by third degree (42.6%) hemorrhoids. 12 % of the patients had major discomfort and 74.6% felt minor discomfort aft er the procedure. 90.6% of the patients had minor bleeding on fi rst passage of stools. Only 6(8%) patients developed recurrence with bleeding and prolapsed. Conclusion: Th e high success rate, cost eff ectiveness and the simplicity of rubber band ligation as an outpatient procedure promotes its use as the fi rst line of treatment for fi rst, second and early third degree hemorrhoids. However its complications like pain and bleeding, though manageable need further evaluation.

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