Rubber band ligation therapy for symptomatic hemorrhoidal disease is a well-accepted treatment modality.
In this study, researchers from Canada evaluated the safety and long-term efficacy of this treatment.
The team performed a retrospective chart review of patients undergoing rubber band ligatures for symptomatic internal hemorrhoids in a single practice.
They documented symptoms, number of bands applied, response, complications, length of follow-up, interval to recurrent symptoms, and subsequent therapy.
The team also obtained additional information from telephone follow-up.
The team defined procedural success as permanent relief of symptoms for follow-up period, marked improvement in symptomatology, or symptom relief for a limited period.
Failure was defined as a modest improvement or no improvement in symptoms.
Overall, 805 patients underwent 2114 rubber band ligatures, however, There 104 patients were lost to follow-up.
The team determined that that most common presenting symptoms were bleeding (91%) and prolapsing (48%).
The median number of bands placed was 2, and the median time between bandings was 4.7 weeks. Median follow-up was 1204 days.
The researchers found that the procedure was successful in 71% of patients. The success rates were similar for all degrees of hemorrhoids.
However, they found that hemorrhoidal disease requiring the placement of ≥4 bands was associated higher failure rates and a greater need for hemorrhoidectomy.
The team identified few complications; bleeding (3%), thrombosed external hemorrhoids (2%), and bacteremia (1%).
They found that higher bleeding rates were encountered with the use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin.
In addition, the team found that time to recurrence lessened with subsequent treatment courses.
Dr Iyer and colleagues concluded, "Rubber band ligatures are safe and effective therapy for symptomatic internal hemorrhoids".
"It can be used to treat all degrees of hemorrhoids with similar effectiveness."
"The likelihood of success is lower if more than four bands are needed to eliminate symptoms."
"The use of acetylsalicylic acid/nonsteroidal anti-inflammatory drugs and warfarin is associated with higher bleeding rates."
"Rubber band ligatures for recurrence of symptoms is effective; however, time to recurrence is less with subsequent treatments."