Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes

Background: Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- and third-degree HD. Methods: A retrospective analysis of second- and third-degree HD cases from November 2017 to August 2021 was performed. Patients on anticoagulants or with other HD degrees were excluded. Follow-up was conducted at 1 month, 3 months, 6 months, 1 year and then every 12 months. Results: 97 patients with second- (20 pts; 20.6%) and third-degree (77 pts; 79.4%) HD with a mean age of 52 years (20–84; SD ± 15.5) were included. Fifty-six patients were men (57.7%) and forty-one women (42.3%). Median follow-up was 13 months (1–26 months). No intraoperative adverse events or drug-related side effects occurred. Minor complications occurred in four patients (4.1%) in the first 30 postoperative days and all resolved after conservative treatment at the 3-month follow-up visit. No mortality or readmissions were observed. Conclusions: Sclerobanding is a safe technique with a low rate of minor postoperative complications. Further studies on larger samples are necessary to establish the effectiveness and long-term outcomes of the technique.

Comparative assessment of efficacy of artery ligation versus rubber band ligation for management of haemorrhoids in Southern Rajasthan

Background: One of the commonest complaints presenting in the surgical out patient department (OPD) is haemorrhoids. Commonest types of haemorrhoids are grade II and III. There is a wide number of modalities that can be adopted for their management. It depends on the skill of the surgeon and preferences of the patient. The present study was designed to ascertain if two modalities of artery ligation and band ligation are comparatively equal or not in managing symptomatic grade II and III haemorrhoids in Rajasthan.Methods: The study comprised of 100 subjects who were randomly divided in two groups based on the procedure to be followed. The subjects were told about the study and its objective.Results: The observations reported that among the selected study population there were more relapses in band ligation as compared to artery ligation.Conclusions: This led to the conclusion that despite its painful and traumatic methodology, haemorrhoid artery ligation still provides a better outcome.

Treatment of Symptomatic Hemorrhoids by Baron’s Band Ligation

Haemorrhoids are a clinical symptom of a change in the normal functional architecture of the inflamed and swollen veins known as the anal cushion. Numerous treatment opportunities are available for this communal issue, but Baron's Gum Ligation (RBL) is the utmost frequently used technique for second- and third-degree haemorrhoids because it treats hemorrhoidal disease without anaesthesia, hospitalization, minimal complications, and ooutpatient discharge is uneventful compared to conventional surgery. Purpose: We conducted this study to evaluate the effectiveness of rubber band ligation in the treatment of second- and third-degree haemorrhoids. Methodology: This prospective study was performed on 76 patients over a six-month period at the Department of General Surgery from January 2021 to June 2021 at Islam Medical College and Teaching Hospital Sialkot. Rubber rubber ligation was used in all patients. A maximum of two haemorrhoids in one session were banded, and third as needed in a check-up done two weeks later. At the end of the fourth week, post-banding assessments were made for the presence and absence of bleeding, pain, and haemorrhoidal prolapse. Results: Of the 76 patients, 60 (78.9%) were male and 16 (21.1%) were female. The M:F ratio was 5.0: 1.0. 37.85 years was the mean age of patients (range 15 to 68). The duration of symptoms in approximately 48 patients (63.2%) was less than one year old, and in 18 (23.7%) patients ranged from 1 to 3 years and 10 (13.2%) patients had symptoms for more than 4 years. Complications occurred in 23 patients, bleeding in three patients, pain in 18 patients, 2 patients have prolapsed. Conclusion: RBL is effective, safe and simple method of symptomatic treatment for 2nd and 3rd degree haemorrhoids in an outpatient setting.

A Cross Sectional Study on the Outcome of Rubber Band Ligation in third Degree Hemorrhoids

Objective: To determine the outcome of rubber band ligation in third degree hemorrhoids. Methods: - This design of this study was cross sectional study. The study was conducted at Shalamar medical and dental college, Lahore and the duration of this study was from April 2020 to September 2021. 215 patients were seen with complain of hemorrhoids, of which 47 had 3rd degree hemorrhoids. All patients with 3rd degree hemorrhoids underwent for rubber band ligation and were enrolled in the study. Outcome in our study was defined as pain, bleeding, constipation, anal fissure/fistula and infection. Chi- square test (χ2) of all qualitative variables was applied by taking p-value < 0.05 as significant. Results: - Of 47 patients admitted with 3rd degree hemorrhoid, 30 were males and 17 were females. The mean age of males was 38.78±12.71 while mean females age were found to be 22.73± 7.25 respectively. The most common complaint following rubber band ligation (RBL) was pain. 19 out of 47 patients were presented with pain followed by bleeding (14), constipation (13), anal fissure/fistula (10) and infection (8) which constitutes about 22.34 %, 22.78%15.32% and 14.03% respectively. There was significant relationship found between gender and anal fissure/fistula with p-value of <0.05. Conclusion: - Patients with 3rd degree hemorrhoids after RBL procedure showed fewer complications comparable to other surgical procedures in the treatment of hemorrhoids. It is the best possible options in third degree internal hemorrhoids. Moreover, this procedure is simple and cost-effective and requires no hospitalization, no anesthesia and no post-operative care. Keywords: - 3rd degree Hemorrhoids, Outcome, Rubber Band Ligation.

Effectiveness and adverse events of endoscopic clipping versus band ligation for colonic diverticular hemorrhage: A large-scale multicenter cohort study

Background and study aims: Prior studies have shown the effectiveness of endoscopic band ligation (EBL) and clipping for colonic diverticular hemorrhage (CDH) but have been small and conducted at single centers. Thus, we investigated which was the more effective and safe treatment in a multicenter long-term cohort study. Patients and methods: We reviewed data for 1,679 patients with CDH who were treated with EBL (n=638) or clipping (n=1,041) between January 2010 and December 2019 at 49 hospitals across Japan (CODE BLUE-J Study). Logistic regression analysis was used to compare outcomes between the two treatments. Results: In multivariate analysis, EBL compared with clipping was independently associated with reduced risk of early rebleeding (adjusted odds ratio [AOR] 0.46; p<0.001) and late rebleeding (AOR 0.62; p<0.001). These significantly lower rebleeding rates with EBL were evident regardless of active bleeding or early colonoscopy. No significant difference was found between the treatments in the rate of initial hemostasis or mortality. EBL compared with clipping independently reduced the risk of need for interventional radiology (IVR) (AOR 0.37; p=0.006) and prolonged length of hospital stay (LOS) (AOR 0.35; p<0.001), but not need for surgery. Diverticulitis developed in 1 patient (0.16%) following EBL and 2 patients (0.19%) following clipping. Perforation occurred in 2 patients (0.31%) following EBL and none following clipping. Conclusions: Analysis of our large endoscopy dataset suggests that EBL is an effective and safe endoscopic therapy for CDH offering the advantages of lower early and late rebleeding rates, reduced need for IVR, and shorter LOS.