A randomized controlled trial of rubber band ligation versus infra-red coagulation in the treatment of internal haemorrhoids

Objective Despite the presence of numerous non-surgical therapies for the t reatment of haemorrhoids, none of these therapies has clearly been proven t o be superior. The effectiveness and patient tolerance of rubber band ligat ion (RBL) and infra-red coagulation (IRC) in the treatment of haemorrhoids was assessed. Design Prospective randomized trial. Setting Academic hospital (tertiary care). Participants A total of 133 consecutive patients (73 males, 60 females, mea n age 48 years (range 19-82)) with internal haemorrhoids, and without conco mitant anorectal disease, were randomized to rubber band ligation (RBL, n = 65) or infra-red coagulation (IRC, n = 68). Interventions Rubber band ligation or infra-red coagulation was performed i n one or more sessions with four-week intervals until symptoms had resolved . Treatment outcome and side-effects were assessed after each treatment ses sion and one month after the last treatment by proctological examination an d a questionnaire, including a pain score (visual analogue scale from 0 to 10). Recurrence of complaints was assessed by telephone questionnaire [mean follow-up of 19.2 months (SD 7.8)]. Results Treatment outcome was assessed in 124 patients (60 RBL, 64 IRC). Th e mean number of treatment sessions was 1.6 (SD 0.9) for both therapies. Fo r RBL, 58 patients (97%), and for IRC, 59 patients (92%) were symptom-free or had satisfactorily improved. Only third-degree haemorrhoids seemed to re spond better to RBL (five of five patients symptom-free) than to IRC (two o f four patients symptom-free). Pain following treatment was more common and more severe after RBL (VAS 5.5 +/- 3.7) than after IRC (VAS 3.3 +/- 3.3, P = 0.018). The telephone questionnaire was answered by 105 patients. Nine o f 50 patients (18%) treated with RBL and 11 of 55 patients (20%, P = 0.81) treated with IRC had experienced symptomatic relapse to pre-treatment level s. Conclusions Infra-red coagulation and rubber band ligation are equally effe ctive in the treatment of haemorrhoids. The rate and severity of pain is hi gher after rubber band ligation. Infra-red coagulation should be the first- line treatment for haemorrhoids. (C) 2000 Lippincott Williams & Wilkins.