THE TREATMENT OF SECOND DEGREE HAEMORRHOIDS BY INJECTION, RUBBER BAND LIGATION, MAXIMAL ANAL DILATATION, AND HAEMORRHOIDECTOMY: A PROSPECTIVE CLINICAL TRIAL

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Abstract
Patients (120) with confirmed 2nd-degree hemorrhoids were randomly allocated to 4 treatment groups: injection, rubber band ligation, maximal anal dilatation, and hemorrhoidectomy. Each group consisted of 30 patients. All patients were regularly followed up for .apprx. 1 yr. Assessment at 1 yr showed that hemorrhoidectomy cured the hemorrhoids in 29 of 30 patients. Rubber band ligation relieved 25 of 30 and maximal anal dilatation 24 out of 30. Injection was the least effective treatment and relieved 18 of the 30 patients, with a cure rate of only 60%. Hemorrhoidectomy caused pain in all cases, anal stenosis in 2, postoperative hemorrhage in 2; the patients required an average hospital stay of 11.5 days and an average of a further 15.5 days off work. Rubber band ligation was painless in 26 patients of 30 and maximal anal dilatation was painless in 25 out of 30. There were no postoperative complications in the latter 2 treatment groups. Hemorrhoidectomy is good in curing the disease, but the higher possibility of postoperative pain and complications and longer hospital stay would not justify its use in the treatment of 2nd-degree hemorrhoids. Rubber band ligation and maximal anal dilatation are effective and relatively free from complications. Rubber band ligation has the additional advantage of not requiring hospital stay or anesthesia and is therefore considered to be the most appropriate method of treatment for 2nd-degree hemorrhoids.