Rubber band ligation or lateral subcutaneous sphincterotomy for treatment of haemorrhoids

Abstract

A randomized trial has been conducted to compare treatment for first- and second-degree haemorrhoids by rubber band ligation and lateral subcutaneous sphincterotomy. The symptomatic results of both procedures were similar at one year, though the initial results of sphincterotomy were poor. Eleven patients later required haemorrhoidectomy—5 after lateral subcutaneous sphincterotomy and 6 after rubber band ligation. Rebanding was necessary in 11 patients treated by rubber band ligation (22 per cent). Immediate complications of pain and bleeding were reported in 27 per cent of patients treated by rubber band ligation compared with 14 per cent after lateral subcutaneous sphincterotomy, whereas 2 patients developed a fistula after lateral subcutaneous sphincterotomy. Lateral subcutaneous sphincterotomy was associated with a 30 per cent reduction in anal sphincter pressure at 4–6 months and the anal pressure was also reduced (by 24 per cent) at 1 year. Rubber band ligation had no influence on anal pressure. The poor results of lateral subcutaneous sphincterotomy occurred in patients with prolapse and with anal pressures of less than 100 cm H2O. Although lateral subcutaneous sphincterotomy is a satisfactory means of treating patients with first- and second-degree haemorrhoids, it requires admission to a day case unit. For this reason lateral subcutaneous sphincterotomy is unlikely to be preferred to rubber band ligation in the outpatient management of piles.