Effectiveness of hemorrhoidal treatment by rubber band ligation and infrared photocoagulation

Objectives: to demonstrate the effectiveness of the treatment of internal h emorrhoids with rubber band ligation (RBL) and infrared photocoagulation (I RC). Patients and methods: from march 1996 to december 1999, we prospectively st udied 358 patients with a total of 817 hemorrhoid groups and a follow-up pe riod of 36 months. Distribution according to gender and age was: 210 men wi th a mean age of 46 years and 148 women with a mean age 45.8 years. The mea n number of hemorrhoids treated per patients was 2.3. All of them had compl ete a follow-up protocol at 15, 30, 60 and 180 days and at 12, 24 and 36 mo nths. Rubber band ligation was performed with McGown (R) ligator and suctio n pump, placing the band at the base of the hemorrhoid. For the infrared co agulation we used a Lumatec (R) coagulation system, applying at least four shoots around each hemorrhoid, with an exposition time ranging between 1 an d 1.5 seconds. Treatment was considered effective when patients became asym ptomatic (relief of pain, bleeding or anal itching) and the obliteration of hemorrhoids after the treatment was confirmed by anal inspection and anosc opy. Results: two hundred ninety five of 358 patients were treated with RBL (82. 4%), this treatment being effective in 98% of the patients after 180 days a nd very good after 36 months, There were 6/295 relapses at 36 months (2%). All minor and major complications were observed within the first 15 days of treatment: rectal tenesmus in 96/295 patients (32.5%). mild anal pain in 1 15/295 (38.9%). self-limited and mild bleeding after the detachment of the bands in 30/295 (10%), and febricula in one patient. Sixty three of 358 pat ients were treated with IRC (17.6%). In this group, relapses were observed in 6/63 patients (9.5%) at 36 months, all of them with grade ill hemorrhoid s that required additional treatment with RBL. All the complications (inher ent to the technique) were observed within the first days: mild anal pain i n 40/63 patients (63.4%) and mild bleeding in 1/63 (1.6%). The treatment wi th RBL or IRC depended on the number of hemorrhoids and the hemorrhoidal gr ade. No significant differences were found regarding the effectiveness betw een RBL and IRC for the treatment of grade I-II hemorrhoids, while RBL was more effective for grade III and IV hemorrhoids (p <0.05). Conclusion: RBL and IRC should be considered as a good treatment for all gr ades of hemorrhoids, due to its effectiveness, its cost-benefit and its sma ll short and long term morbidity.