Published: 2021-06-28

Study of efficacy of band ligation and suture ligation in the treatment of second degree hemorrhoids

S. N. Gole, Nitin Toppo, Manoj Poptani


Background: Rubber band ligation (RBL) and suture ligation are treatment strategies adapted for management of second degree hemorrhoids, an anorectal condition leading to distal displacement of anal cushions. Aim of current study was to investigate efficacy of suture ligation and band ligation techniques used in management of grade two internal hemorrhoids in terms of intraoperative n post-operative complications.

Methods: An observational prospective study was conducted on 108 patients presented with grade 2 internal heamorrhoids at JNM medical college, Raipur between 2018 to 2019. Patients were divided in two equal groups receiving rubber band and suture ligation as treatment approaches. Efficacy of both treatment approaches was studied in terms of post-operative complications observed at immediate, one week and one month follow-ups and on the basis of hospital stay time required.

Results: Majority of patients in both the groups were males with most number of cases in age group of 31-40 years. There was no significant difference in dietary habits of patients in both group as well as efficacy of both treatment techniques. Post-operative pain, discomfort, prolapse were common complains in band ligation group with pain persisting even during one month follow-up. Pain, bleeding per rectum, discomfort and irritation per rectum were the most common post-operative complaints of suture ligation group during follow-up.

Conclusions: Although efficacy of both treatment strategies were equivalent, RBL would be recommended over suture ligation treatment strategy due to requirement of regional anesthesia to reduce operative difficulty and more hospital stay time in suture ligation treatment strategy.


Grade 2 hemorrhoids, Rubber band ligation, Suture ligation

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Lohsiriwat V. Hemorrhoids: from basic pathophysiology to clinical management. World J Gastroenterol. 2012;18(17):2009-17.

Sun Z, Migaly J. Review of hemorrhoid disease: presentation and management. Clin Colon Rectal Surg. 2016;29(1):22-9.

Mott T, Latimer K, Edwards C. Hemorrhoids: diagnosis and treatment options. Am Fam Physician. 2018;97(3):172-9.

Lohsiriwat V. Approach to hemorrhoids. Curr Gastroenterol Rep. 2013;15(7):332.

Thomson WH. The nature of haemorrhoids. Br J Surg. 1975;62(7):542-52.

Rubbini M, Ascanelli S. Classification and guidelines of hemorrhoidal disease: Present and future. World J Gastrointest Surg. 2019;11(3):117-21.

Margetis N. Pathophysiology of internal hemorrhoids. Ann Gastroenterol. 2019;32(3):264-72.

Gass OC, Adams J. Hemorrhoids; etiology and pathology. Am J Surg. 2010;79:40-3.

Riss S, Weiser FA, Schwameis K, Riss T, Mittlböck M, Steiner G, et al. The prevalence of hemorrhoids in adults. Int J Colorectal Dis. 2012;27(2):215-20.

Johanson JF, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. An epidemiologic study. Gastroenterology. 2014;98(2):380-6.

Lohsiriwat V. Treatment of hemorrhoids: a coloproctologist's view. World J Gastroenterol. 2015;21(31):9245-52.

Villalba H, Abbas MA. Hemorrhoids: modern remedies for an ancient disease. Perm J. 2007;11(2):74-6.

Acheson AG, Scholefield JH. Management of haemorrhoids. BMJ. 2008;336(7640):380-3.

Cocorullo G, Tutino R, Falco N, Licari L, Orlando G, Fontana T, et al. The non-surgical management for hemorrhoidal disease. a systematic review. G Chir. 2017;38(1):5-14.

Sekowska M, Koscinski T, Wierzbicki T, Hermann J, Drews M. Treatment of the hemorrhoids and anal mucosal prolapse using elastic band ligature--early and long term results. Pol Przegl Chir. 2011;83(12):654-61.

Trompetto M, Clerico G, Cocorullo G, Giordano P, Marino F, Martellucci J, et al. Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol. 2015;19(10):567-75.

Agbo SP. Surgical management of hemorrhoids. J Surg Tech Case Rep. 2011;3(2):68-75.

Cerato MM, Cerato NL, Passos P, Treigue A, Damin DC. Surgical treatment of hemorrhoids: a critical appraisal of the current options. Arq Bras Cir Dig. 2014;27(1):66-70.

Arezzo A, Podzemny V, Pescatori M. Surgical management of hemorrhoids. State of the art. Ann Ital Chir. 2011;82(2):163-72.

Brown SR. Haemorrhoids: an update on management. Ther Adv Chronic Dis. 2017;8(10):141-7.

Pescatori M, Gagliardi G. Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol. 2008;12(1):7-19.

Kunitake H, Poylin V. Complications following anorectal surgery. Clin Colon Rectal Surg. 2016;29(1):14-21.

Romaguera VP, Sancho-Muriel J, Alvarez-Sarrdo E, Millan M, Garcia-Granero A, Frasson M. Postoperative complications in hemorrhoidal disease and special conditions. Rev Recent Clin Trials. 2021;16(1):67-74.

Picchio M, Greco E, DiFilippo A, Marino G, Stipa F, Spaziani E. Clinical outcome following hemorrhoid surgery: a narrative review. Indian J Surg. 2015;77(3):1301-7.

Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg. 2015;100(1):44-57.