OFFICE BASE MANAGEMENT OF NON-PROLAPSED INTERNAL HEMORRHOIDS: SINGLE VERSUS DOUBLE BAND LIGATION

Abstract

Objective: To compare single versus double band ligation in the office based management of non-prolapsed internal hemorrhoids.

Study Design: Randomized controlled trial.

Place and Duration of Study: Outpatient department of Surgery, CMH Rawalpindi, from Jan 2015 to Dec 2016.

Material and Methods: All patients (216 patients, 108 in each group) presenting with bleeding, non-prolapsed internal hemorrhoids were included in the study after approval from hospital ethical committee. Patients with bleeding disorders and other ano-rectal conditions causing bleeding per rectum were excluded. Lignocaine gel (2%), disposable proctoscope, Barron’s ligator with grasper & black silicon bands (Germany) of 2mm diameter were used. The follow up regimen inclusive of Polycarbophil (Fibercon) sachet, Micro Purified Flavonoid Fraction (MPFF) (Daflon 500mg) and warm water sitz bath was same for both the groups of our study.

Results: A total of 216 patients meeting the inclusion and exclusion criteria were selected and divided into two equal groups. In group A of double band ligation, mean age was 39.3 ± 1.7 years and mean time for fall of band was 6.6 ± 1.3 days (p=0.000). While in group B of single band ligation, mean age was 41.2 ± 2.1 years & mean time for fall of band was 7.2 ± 1.5 days (p=0.03) while the mean time of fall between the two groups was insignificant (p=0.251).

Conclusion: Double band ligation for non-prolapsed bleeding hemorrhoids was found more simple, accessible,cost effective and more reliable than the single band ligation. Frequent visits of the patient can be minimized. The complications in both groups are same. It has reasonable early recovery, but equivocal recurrence.