Rubber Band Ligation Versus Medical Therapy For Treatment of Grade II-III Hemorrhoids

The most prevalent clinical proctological disorder is internal hemorrhoids. Surgical treatment is a common treatment strategy for this disease. However, due to its significant complications, non-invasive methods are usually more on the agenda. This study aimed to evaluate the treatment results of patients with internal hemorrhoids with rubber band ligation and medication treatment and their one-year follow-up.

The current randomized clinical trial was performed on 57 patients with rectal bleeding caused by grade II and III internal hemorrhoids. The patients were randomly divided into two groups of medication treatment and rubber band ligation. The medication treatment with anti-hemorrhoid cream was performed three times a day until complete management of bleeding. The rubber band ligation was performed for another group of patients, and the patients’ need for re-ligation was assessed by monthly examination. Treatment outcomes, recurrence, and complications were compared between the two groups in a 12-month follow-up.

In the medication treatment group, the Mean±SD duration of using anti-hemorrhoid cream for bleeding management was 5.05±2.17 days. In 83.2% of patients, bleeding was controlled well within 6-8 days. The Mean±SD recurrence rate of bleeding was reported 53.3±1.94 times in one year. There was an inverse relationship between patients’ age and recurrence of bleeding (r= -0.78, P<0.001). In the other group treated with rubber band ligation, 25%, 29.6%, and 44.4% of patients required rubber band ligation once, twice, and three times, respectively. Three patients (11.11%) in the rubber band ligation group suffered from complications, including pain (two patients: 7.40%) and minor bleeding (1 patient: 3.70%).

Regarding the minor complications and the remarkable success of rubber band ligation in the eradication of grade II and III hemorrhoids, this method can be recommended as a selective approach of low to moderate hemorrhoids’ treatment, especially treatment-resistant types.