Triple rubber band ligation for hemorrhoids - Prospective, randomized trial of use of local anesthetic injection

PURPOSE: Rubber band ligation is a common office procedure for hemorrhoids. Triple rubber band ligation in a single session has been shown to be a saf e and economical way of treating hemorrhoids. However, postligation discomf ort after triple rubber band ligation is not uncommon. The aim of this stud y was to evaluate the effectiveness of local anesthetic injection to the ba nded hemorrhoidal tissue in reducing postligation discomfort. METHODS: Pati ents attending an outpatient clinic for symptomatic hemorrhoids suitable fo r triple rubber band ligation were randomly assigned to two groups. In the treatment group rubber band ligation was performed at three columns of hemo rrhoids, and 1 to 2 mi of 2 percent lignocaine was injected into the banded hemorrhoidal tissue. In the control group triple rubber band ligation was performed in a similar manner, but local anesthetic was not given. Patients were followed up by telephone at the second week and in the clinic after s ix weeks. RESULTS: From April to August 1996, 101 patients entered the tria l and were treated with triple rubber band ligation. Sixty-two patients wer e randomly assigned to the local anesthetic injection group and 39 to the c ontrol group. Overall good to excellent results occurred in 89 percent of p atients, and there was no difference between the two groups. Postligation p ain occurred in 26 and 20 percent of patients in the treatment and control groups, respectively (P > 0.05). Postligation tenesmus occurred in 32 and 4 1 percent of patients in the treatment and control groups, respectively (P > 0.05). No patients suffered from septic complications or bleeding that re quired transfusion. CONCLUSION: Triple rubber band ligation in a single ses sion is a safe, economical, and effective way of treating symptomatic hemor rhoids. Postligation pain and tenesmus occurred in 24 and 37 percent, respe ctively. Discomfort was usually tolerable. Local anesthetic injection to th e banded hemorrhoidal tissue did not help to reduce postligation discomfort .