OUTCOME OF THE RUBBER BAND LIGATION WITH MILLIGAN MORGAN HAEMORRHOIDECTOMY
Abstract
Background: Haemorrhoids is a common anorectal disease seen in our society. Conservativemanagement is usually adopted for 1st and 2nd degree haemorrhoids. Patients who do not respond to
above management are the candidates for other modalities of treatment which includes sclerotherapy,
rubber band ligation, cryosurgery and stapler gun or open haemorrhoidectomy. The purpose of study
was to compare the outcome of the Rubber band ligation with Milligan Morgan haemorrhoidectomy in
patients with 2nd and 3rd degree haemorrhoids. Methods: Hundred diagnosed admitted patients of
uncomplicated 2nd and 3rd degree piles were treated either with rubber band ligation (RBL) or open
method of Milligan Morgan (OH) for the period from January 2007 to December 2007 were included
in the study. Both procedures were evaluated regarding effectiveness, safety, complications after
procedures, hospital stay and return to work on a written Performa. Patients with 1st and 4th degree
haemorrhoids, below the age of 12 years, bleeding diathesis, associated local anorectal conditions
requiring surgery, complicated haemorrhoids, recurrent and secondary haemorrhoids were excluded
from the study. Follow up of all these patients was done in OPD to assess any complication and
recurrence. Data was analysed through SPSS-16.0. Results: One hundred indoor patients with 2nd and
3rd degree haemorrhoids were treated either with rubber band ligation or open technique. Most (>90%)
of the patients were males. Majority of the patients were in 30-33 years age group. Fresh bleeding
(90%) and constipation (45%) were the commonest symptoms followed by prolapsed, discharge and
irritation. Second degree was more common than 3rd degree haemorrhoids. Intensive pain was the
commonest complain after both the procedures, however faecal incontinence was not reported in either
group. Hospital stay was longer in open technique (70%) compare to few hours to one day in rubber
band ligation group. Return to work was earlier in patients treated with rubber band ligation.
Conclusion: Rubber band ligation is safe and effective method compare to open technique in 2nd and
3rd degree symptomatic haemorrhoids.
Keywords: Haemorrhoids, rubber band ligation, Milligan Morgan Procedure, Outcome
References
Bhat SM. Rectum and anal canal. SRB's manual of surgery.3rd
edition. New Dehli: Jaypee Brother; 2009. p. 888-927.
Tan EK, Cornish J, Darzi AW, Papagrigoriadis S, Tekkis PP.
Meta-analysis of short-term outcomes of randomized controlled
trials of Ligature vs conventional hemorrhoidectomy. Arch Surg
;142:1209-8.
William NS, Russell RCG, Williams NS, Bulstrode CJK. The
anus and anal canal. In: Bailey & Love Short Practice of Surgery.
th ed. London: 2006;1255-62.
Ohning GV, Machicado GA, Jensen DM. Definitive Therapy for
Internal Hemorrhoids-New Opportunities and Options. Rev
Gastroenterol Disord 2009;9(1):16-26.
Wallis de Vries BM , Van der Beek ES, Wijkerslooth LR, Zwet
WC, Van der Hoeven JA, Schattenkerk M, et al. Treatment of
Grade 2 and 3Hemorrhoids with Doppler-Guided Hemorrhoidal
Artery Ligation. Dig Surg 2007;24:436-40.
Sandhu PS, Singh K. A randomized comparative study of
micronised flavonoids and rubber band ligation in the treatment
of acute internal haemorrhoids. Indian J Surg 2004;66:281-5.
Acheson AG, Scholefield JH. Management of haemorrhoids.
BMJ 2008;336:380-3.
Gencosmanoglu R, Sad O, Koc D, Inceoglu R.
Hemorrhoidectomy: open or closed technique? A prospective,
randomized clinical trial. Dis Colon Rectum 2002;45:70-75.
Johanson JF. Nonsurgical treatment of hemorrhoids. J
Gastrointest Surg 2002;6:290-4.
Thomson WH. The nature of haemorrhoids. Br J Surg
;62:542-52.
Sardinha TC, Corman ML. Hemorrhoids. Surg Clin North Am
;82:1153-67.
Onso-Coello P, Guyatt G, Heels-Ansdell D, Johanson JF,
LopezYarto M, Mills E, et al. Laxatives for the treatment of
hemorrhoids. Cochrane Database Syst Rev 2005;4:CD004649.
Evans CFM, Hyder SA, Middleton SB. Modern surgical
management of haemorrhoids. Pelviperineology 2008;27:139-42.
Su MY, Chiu CT, Wu CS, Ho YP, Lien JM, Tung SY, et al.
Endoscopic hemorrhoidal ligation of symptomatic internal
hemorrhoids. Gastrointest Endosc 2003;58:871-4.
MacRae HM, McLeod RS. Comparison of hemorrhoidal
treatment modalities. A meta-analysis. Dis Colon Rectum
;38:687-94.
Milligan E, Morgan C. Surgical anatomy of the anal canal and
operative treatment of hemorrhoids. Lancet 1937;2:1119-24.
Ferguson JA, Heaton JR. Closed hemorrhoidectomy. Dis Colon
Rectum 1959;2:176-9.
Majid A, Malik AM, Butt MQ. Hemorrhoids;management by
rubber band ligation. Professional Med J 2006;13:664-8.
Gebbensleben O, Hilger Y , Rohde H. Do we at all need surgery
to treat thrombosed external hemorrhoids? Results of a
prospective cohort study. Clin Exp Gastroenterol 2009:2 69-74.
Talley NJ. How to Do and Interpret a Rectal Examination in
Gastroenterology. Am J Gastroenterol 2008;103:820-2.
Fraser A. Office proctoscopy and sigmoidoscopy. Australian
family physician 1990; 19(5): 661-3.
Gearhart SL. Symptomatic hemorrhoids. Adv Surg
;38:167-82.
Perez-Miranda M, Gomez-Cedenilla A, Leon-Colombo T,
Pajares J, Mate-Jimenez J.. Effect of fiber supplements on
internal bleeding hemorrhoids. Hepatogastroenterology
;43:1504-7.
Dodi G, Bogoni F, Infantino A, Pianon P, Mortellaro LM, Lise
M. Hot or cold in anal pain? A study of the changes in internal
anal sphincter pressure profiles. Dis Colon Rectum
;29:248-251.
Shafik A. Role of warm-water bath in anorectal conditions. The
thermosphincteric reflex. J Clin Gastroenterol 1993;16:304-8.
Ho YH, Tan M, Seow-Choen F. Micronized purified flavonidic
fraction compared favorably with rubber band ligation and fiber
J Ayub Med Coll Abbottabad 2010;22(4)
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Asad.pdf
alone in the management of bleeding hemorrhoids: randomized
controlled trial. Dis Colon Rectum 2000;43:66-69.
Misra MC, Parshad R. Randomized clinical trial of micronized
flavonoids in the early control of bleeding from acute internal
haemorrhoids. Br J Surg 2000;87:868-72.
La Torre F, Nicolai AP. Clinical use of micronized purified
flavonoid fraction for treatment of symptoms after
hemorrhoidectomy: results of a randomized, controlled, clinical
trial. Dis Colon Rectum 2004;47:704-10.
Madoff RD, Fleshman JW, Clinical Practice Committee,
American Gastroenterological Association. American
Gastroenterological Association technical review on the
diagnosis and treatment of hemorrhoids. Gastroenterology
;126:1463-73.
Corman ML. Colon and rectal surgery. 5th ed. Philadelphia:
Lippincott Williams & Wilkins; 2004. p.177-253.
Jr Zollinger RM, Zollinger RM. Open haemorrhoidectomy.
Atlas of surgical operations.17th edi.Mc Graw Hill Inc USA
:174-87.
Tan WTL. Rubber band ligation of haemorrhoids. Singapore
Med J 1980;21:517-21.
Hashmi F, Siddiqui FG, Jamal A. Role of topical glyceryl
trinitrate as an adjunct following milligan-morgan's
haemorrhoidectomy. J Surg Pak 2008;13(3):108-11.
Parks AG. Surgical treatment of haemorrhoids. Brit J Surg
;43:337-51.
Holzheimer RG. Hemorrhoidectomy: Indications and risks. Eur J
Med Res 2004:9:18-36.
McArthur DR, Badiani S, Karandikar S. Current Trends in the
Management of Haemorrhoids. Bombay Hospital Journal
;50:343-8.
Hetzer FH, Demartines N, Handschin AE, Clavien PA. Stapled
vs Excision Hemorrhoidectomy. Arch Surg. 2002;137:337-40.
Qureshi S, Aziz T, Afzal A, Maher M. Rubber band ligation of
symptomatic Internal haemorrhoids; result of 450 Cases. J Surg
Pak 2009;14(1):19-22.
Lyer VS, Shrier I, Gordon PH. Long term outcome of rubber
band ligation for symptomatic primary and recurrent internal
hemorrhoids. Dis Colon Rectum2004;47:1364-70.
Cho SW, Lee RA, Chung SS, Kim KH. Early Experience of
Doppler-Guided Hemorrhoidal Artery Ligation and Rectoanal
Repair (DG-HAL & RAR) for the Treatment of Symptomatic
Hemorrhoids. J Korean Surg Soc 2010;78:23-8.
Ali U, Samad A. Rubber band ligation versus open
haemorrhoidectomy: A study of 100 cases. J Pakistan Med
Institute. 2005;19:317-22.
Bernal JC, Enquix M, Lopez Garcia J, Garcia Romero J,
Trullenque Peris R. Rubber band ligation for hemorrhoids in a
colorectal unit. A prospective study. Rev Esp Enferm Dig
;97:38-45.
Law WL, Chu KW. Triple rubber band ligation for hemorrhoids:
prospective randomized trial of use of local anesthetic injection.
Dis Colon Rectum 1999; 42: 363-6.
Pokharel N, Chhetri RK, Malla B, Joshi HN, Shrestha RKM.
Haemorrhoidectomy: Ferguson's (closed) vs Milligan Morgan's
technique (open). Nepal Med Coll J 2009;11(2):136-7.
Arabi Y, Alexander-Williams J, Keighley MRB. Anal pressures
in hemorrhoids and anal fissure. Am J Surg 1977; 134:608-10.
Wrobleski DE. Rubber band ligation of hemorrhoids. Rhode
Island Med 1995;78:172-3.
Downloads
Published
How to Cite
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.