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

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

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