Efficacy and safety of combined endoscopic rubber band ligation in the treatment of grade II-III prolapsed hemorrhoids: a retrospective study (with video).

BACKGROUND

Hemorrhoids is one of the most common anorectal diseases. In recent years, the incidence rate of hemorrhoids has been rising.

AIMS: To investigate the efficacy and safety of combined endoscopic rubber band ligation (ERBL) in the treatment of grade II-III prolapsed internal hemorrhoids.

METHODS

Patients with grade II-III prolapsed internal hemorrhoids treated from January 2019 to June 2023 were reviewed.

RESULTS

Complete resolution was achieved in 124 cases (91.85%), partial resolution in 7 cases (5.19%), and recurrence in 4 cases (2.96%). 34 (25.19%) cases experienced anal pain after procedure, with a median visual analog scale (VAS) score of 0 (0-3). Postoperative bleeding occurred in 18 (13.33%) cases. Anal swelling was observed in 19 (14.07%) cases, and urinary retention occurred in 4 cases (2.96%). The incidence of postoperative pain (30.43% vs. 11.6%, P = 0.018) and VAS scores (0 vs. 0, P = 0.003) in the ligate three hemorrhoids group were significantly higher compared to the ligate two hemorrhoids group. There was no significant difference in long-term efficacy between the two groups. Male [odds ratio (OR) 5.654, 95% confidence interval (CI) 1.222-26.159; P = 0.027] and postoperative complications (OR 4.914, 95% CI 1.080-22.345; P = 0.039) were independent risk factors that were incomplete resolution.

CONCLUSIONS

Combined ERBL is an efficient and safe method for grade II-III prolapsed internal hemorrhoids. The number of hemorrhoids ligated had no significant effect on the long-term outcome, but the ligation of three hemorrhoids was associated with an increased incidence of postoperative pain. Male and postoperative complications are risk factors for incomplete resolution.