Rubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: A long term prospective clinical trial

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Abstract
Eighty patients with prolapsing haemorrhoids, randomly treated by either rubber band ligation (n = 39) or haemorrhoidectomy (n = 41), were assessed 12 and 42 months after treatment. Thirty-eight patients in each group presented with rectal bleeding. Twelve months later, 36 in the rubber band ligation group and 37 in the haemorrhoidectomy group had benefited from treatment. After 42 months, all patients in the rubber band ligation group reported improvement in this symptom; one in the haemorrhoidectomy group did not. At 12 months all but one patient in the rubber band ligation group and all in the haemorrhoidectomy group had improved with respect to haemorrhoidal prolapse. At 42 months all except one in each group reported improvement in this symptom. Anal pain, pruritus ani and soiling are symptoms commonly associated with haemorrhoids. All were improved by both rubber band ligation and haemorrhoidectomy. Neither technique was superior in this respect and there was no change in results between 12 and 42 months. Relief from symptoms of haemorrhoids at 12 months, obtained by rubber band ligation or by haemorrhoidectomy, is maintained 42 months after treatment. Thus, rubber band ligation has a good long term outcome and, as a convenient outpatient procedure, should continue to be advocated as the first-line management for prolapsing haemorrhoids.