Infrared coagulation and rubber band ligation in the treatment of early stage hemorrhoids

Yıl 2006, Cilt: 5 Sayı: 3, 179 - 183, 01.12.2006

Fahri Yakaryılmaz Sefa Güliter Zübeyde Özkurt Hatice Keleş Fatma Ebinç

Öz

Background/aim: Although there are different non-surgical methods for the treatment of symptomatic hemorrhoids, which method is superior remains controversial. The aim of this study was to investigate the effectiveness and complications of rubber band ligation (RBL) and infrared coagulation (IRC) in the treatment of early stage hemorrhoids. Materials and methods: In this randomized prospective study, previously untreated 91 patients (51 female, 40 male; median age 42 (21-64) yrs) with second degree internal hemorrhoids diagnosed by flexible sigmoidoscopy and anoscopic examination underwent either RBL (n=45) or IRC (n=46) in two sessions with a four-week interval. Effectiveness, adverse effects and complications of each treatment method were evaluated at the end of the first week after each treatment session and at the 2nd, 12th and 24th months after the last session. Pain was evaluated with visual analogue scale (VAS) scored between 0-10. Results: The average treatment sessions were similar in both groups (RBL 1.73±0.45, IRC 1.78±0.42, p>0.05). The mean VAS scores for spontaneous pain at the end of the first week in the RBL and IRC groups were 3.8±2.1 and 2.4±2.0, respectively (p

Anahtar Kelimeler

Hemorrhoid, rubber band ligation, infrared coagulation

Erken evre hemoroid tedavisinde infrared koagulasyon ve lastik bant ligasyon

Öz

Giriş ve amaç: Semptomatik hemoroidlerin tedavisi için cerrahi dışı farklı yöntemler olmasına rağmen bunların hangisinin daha üstün olduğu tartışmalıdır. Bu çalışmada erken evre hemoroidlerin tedavisinde lastik bant ligasyon (LBL) ve infrared koagulasyon (IRK)’un etkinliğinin ve komplikasyonlarının araştırılması amaçlandı. Gereç ve yöntem: Randomize prospektif bu çalışmada fleksible sigmoidoskopi ve anoskopik inceleme ile 2. derece internal hemoroid tanısı konulan, daha önce tedavi edilmemiş 51’i kadın, 40’ı erkek, median yaşı 42 (21–64) yıl olan 91 hastaya semptomlar kaybolana kadar 4 hafta ara ile bir veya daha fazla seansta LBL (n=45) veya IRK (n=46) uygulandı. Her seanstan bir hafta sonra ve son seanstan 2, 12 ve 24 ay sonra tedavilerin etkinliği ve komplikasyonları değerlendirildi. Ağrı değerlendirmesi 0 ile 10 arasında skorlanan vizüel analog skala (VAS) ile yapıldı. Bulgular: LBL ve İRK gruplarında ortalama tedavi seans sayısı benzerdi (1.73±0.45 ve 1.78±0.42, p > 0.05). Postoperatif birinci hafta sonunda spontan ağrı için ortalama VAS skorları LBL ve IRK gruplarında sırası ile 3.8±2.1 ve 2.4±2.0 idi (p < 0.05). LBL grubunda VAS skoru > 5 olan hasta sayısı 5 iken, IRK grubunda 0 idi (p < 0.05). Birinci hafta sonunda rektal tenezm sıklığı LBL grubunda %26.6, IRK grubunda %6.5 bulundu (p < 0.01). Sekizinci hafta sonunda iki grupta da hiçbir hastanın rektal ağrı ve/veya tenezm yakınması yoktu. LBL ve IRK’nın rektal kanamayı önlemedeki başarısı sırası ile 2. ayda %97.8 ve %89.1 (p > 0.05), 12. ayda %88.9 ve %82.6 (p > 0.05), ve 24. ayda %86.7 ve %54.3 (p < 0.01) idi. Sonuç: LBL ikinci derece hemoroidlerin kanama kontrolünde IRK’dan daha etkilidir.
Ancak postoperatif erken komplikasyonlar LBL’de daha sıktır. Postopreratif 2. yıl nüks IRK’da daha sık olmasına rağmen komplikasyonların azlığı nedeni ile erken evre hemoroidlerin tedavisinde IRK ilk basamak tedavi seçeneği olabilir.

Anahtar Kelimeler

Hemoroid, lastik bant ligasyonu, infrared koagulasyon

Kaynakça

• Leff E. Haemorrhoids: current approaches to an ancient problem. Postgraduate Medicine 1987; 82: 95-101.
• Donnison AR, Wherry DC, Morria DL. Hemorrhoids. Nonoperative management. Surg Clin North Am 1988; 88: 1401-9.
• Cataldo P, Ellis CN, Gregorcyk S, et al. Practice parameters for the mamagement of hemorrhoids (revised). Dis Colon Rectum 2005; 48: 189-94
• Arullani A, Cappello G. Diagnosis and current treatment of he- morrhoidal disease. Angioloy 1994; 45: 560-5.
• Ambrose NS, Hares MM, Alexander WJ, Koighloy M. Prospective randomised comparison of photocoagulation and rubber band liga- tion in treatment of haemorrhoids. BMJ 1983; 200: 1389-91.
• Waker AJ, Laicaaler RJ, Nicolle RJ, et al. A prospective study of inf- rared coagulation, injection and rubber band ligation in the treat- ment of haemorrhoids. Int J Colorectal Dis 1990; 5: 113-8.
• Templeton JL, Spence R, Kennedy TL, et al. Comparison of infrared coagulation and rubber band ligation for first and second degree haemorrhoida: a randomised prospective clinical trial. BMJ 1983; 286: 1387-9.
• Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrho- ida: a comperative analysis of infrared coagulation, rubber band li- gation and injection sclerotherapy. Am J Gastroenterol 1992; 87: 1601-6.
• Denniaon A, Whiaton RJ, Rooney S, et al. A randomised comparison of infrared photocoagulation with bipolar diathermy for the outpa- tient treatment of hemorrhoids. Dis Colon Rectum 1990; 33: 32-4.
• Konings M, Debets JM, Baeten CG. Rubber band ligation of he- morrhoids: symptoms almost gone after 6 weeks, but many patients need retreatment in the long run. Nederlands Tijdschrift Voor Gene- eskunde 1999; 143: 1265-8.
• Bonneti R, Friedman M, Goligher J. Late result of haemorrhoidec- tomy by ligature and excision. BMJ 1963; 11: 216-9.
• Read MG, Read NW, Haynes WG, et al. A prospective study of the haemorrhoidectomy on sphincter function and feocal continence. Br J Surg 1982; 69: 396-9.
• Felt-Bersma RJ, van BR, Kobrevsar M, et al. Unsuspected sphincter defect shown by anal endosonography after anorectal surgery. A prospective study. Dis Colon Rectum 1995; 39: 249-53.
• Janssen L. Consensus haemorrhoids. Ned Tijdschrift Goneeskd 1994; 138: 2106-9.
• Bullock N. Impotence after sclerotherapy of haemorrhoids: case re- ports. BMJ 1997; 196: 314-9.
• Goligher J. Surgery of the anus, Rectum and Colon, 5th edd. London: Bailliere-Tindall; 1984.
• Kaman L, Aggarwal S, Kumar R, et al. Necrotizing fascitis after in- jection sclerotherapy for hemorrhoids: report of a case. Dis Colon Rectum 1999; 42: 419-20.
• Neiger A. Hemorrhoids in everyday practice. Proctology 1979; 2: 22-8.
• Tajana A, Chiurazzi D, De Lorenzi I. Infrared photocoagulation, cryosurgery and laser surgery in hemorrhoidal disease. Annali Ita- liani di Chirurgia 1995; 66: 775-82.
• Nath G. The new principle of infra-red coagulation in medicine and its physical fundamentals. Colo-Proctology International 1981; 3: 379-81.
• Barron J. Office ligation treatment of haemorrhoids. Dis Colon Rec- tum 1963: 8: 109-13.
• Di Giorgio A, Arnone P, Canavese A, et al. Ambulatory treatment of hemorrhoidal pathology with elastic bands according to a modified Baron technique. Annali Italiani di Chirurgia 1997; 68: 687-92.
• Armstrong DN. Multiple hemorrhoidal ligation: a prospective, ran- domized trial evaluating a new technique. Dis Colon Rectum 2003; 46: 179-86.
• Su MY, Tung SY, Wu CS, et al. Long-term results of endoscopic he- morrhoidal ligation: two different devices with similar results. En- doscopy 2003; 35: 416-20.
• Poen AC, Felt-Bersma RJ, Cuesta MA, et al. A randomized control- led trial of rubber band ligation versus infra-red coagulation in the treatment of internal haemorrhoids. Eur J Gastroenterol Hepatol 2000; 12: 535-9.
• Komborozos VA, Skrekas GJ, Pissiotis CA. Rubber band ligation of symptomatic internal hemorrhoids: results of 500 cases. Digestive Surgery 2000; 17: 71-6.
• Gupta PJ. Infrared coagulation versus rubber band ligation in early stage hemorrhoids. Braz J Med Biol Res 2003; 36: 1433-9.
• Russell TR, Donohue JH. Hemorrhoidal banding. A warning. Dis Colon Rectum 1985; 28: 291-3.
• Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrho- ids: a comparative analysis of infrared coagulation, rubber band li- gation and injection sclerotherapy. Am J Gastroenterol 1992; 87: 1601-6.
• Dickey W, Garrett D. Hemorrhoid banding using using videoendos- kopic anoscopy and a single-handed ligation: an effective, inexpen- sive alternative to endoscopic band ligation. Am J Gastroenterol 2000; 95: 1714-6.
• Alemdaroglu K, Ulualp KM. Single session ligation treatment of bleeding hemorrhoids. Surgery Gynecology and Obstetrics 1993; 177: 62-4.
• Bat L, Melzer E, Koler M, et al. Complications of rubber band liga- tion of symptomatic internal hemorrhoids. Dis Colon Rectum 1993; 36: 287-90.
• Marshman D, Huber Jr PJ, Timmerman W, et al. Hemorrhoidal li- gation. A review of efficacy. Dis Colon Rectum 1989; 32: 369-71.
• Quevedo-Bonilla G, Farkas AM, Abcarian H, et al. Septic compli- cations of hemorrhoidal banding. Archives of Surgery 1988; 123: 650-1.
• Wochter DG, Luna GK. An unusual complication of rubber band li- gation of hemorrhoids. Dis Colon Rectum 1987; 30: 137-40.
• Odelowo OO, Mekasha G, Johnson MA. Massive lifethreatening lo- wer gastrointestinal hemorrhage following hemorrhoidal rubber band ligation. J National Medical Association 2002; 94: 1089-92.
• Novah EI. The outpatient management of internal hemorrhoids by infrared coagulation. Revista Médica de Panamá 1993; 18: 166-70.
• MacRae H, McLeod R. Comparison of hemorrhoidal treatment mo- dalities: A meta-analysis. Dis Colon Rectum 1995; 38: 887-94.