Randomized controlled trial comparing rubber band ligation with stapled haemorrhoidopexy for Grade II circumferential haemorrhoids: long-term results.

Journal article

OBJECTIVE: An improved understanding of the pathophysiology of haemorrhoids has resulted in the introduction of new surgical techniques including stapled haemorrhoidopexy (SH). This randomized controlled trial compared the long-term effectiveness of SH with rubber band ligation (RBL) in the treatment of grade II circumferential symptomatic haemorrhoids. METHOD: A consecutive cohort of patients was randomly allocated to either SH or RBL. Data on haemorrhoidal symptoms, Cleveland continence scores, sphincter assessment, SF-36, EQ-5D, HAD score and prior treatment history were assessed at enrollment and reassessed by long-term postal questionnaire. The details were analysed using spss 12.0 from Microsoft Access. RESULTS: Sixty patients were allocated by computer block randomization. Both groups were balanced for age, sex and symptoms. Recurrence favoured SH [3 vs 11; OR 0.18, 95% CI (0.03 to 0.86), P = 0.028] at 1 year and, at a mean of 40.67 (31-47) months [4 vs 12; OR 0.23, 95% CI (0.05, 0.95); P = 0.039]. SH patients experienced prolonged pain [Median (IQR) = 7 (5,7) vs 3 (1,7), P = 0.008] and took a longer time to return to work [6 (3,7) vs 3 (1,6) days, P = 0.018]. This was no significant difference in quality of life. CONCLUSION: Stapled haemorrhoidopexy achieved better disease control at 1 year without any major complication. This was sustained in the long-term. Further studies with greater patient numbers are needed to confirm this study.

Authors: Shanmugam, V; Muthukumarasamy, G; Cook, J; Vale, L; Watson, A

• Publication status: Published
• Journal: Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
• Volume: 12
• Issue: 6
• Pages: 579-586
• Publication date: 2010-06-01
• DOI: 10.1111/j.1463-1318.2009.01841.x
• EISSN: 1463-1318
• ISSN: 1462-8910
• Language: English
• Keywords: Middle Aged; Surgical Stapling; Female; Ligation; Adult; Young Adult; Aged; Pilot Projects; Postoperative Complications; Hemorrhoids; Male; Proctoscopy; Recurrence; Humans