Comparison of Infrared Coagulation and Rubber Band Ligation

Two Simple and Cost Effective Office Procedures for Internal Haemorrhoids

Abstract
Background: Patients with haemorrhoids or piles visit surgical outpatient departments frequently and are offered various methods of treatment, including some day care surgery. Infrared coagulation and rubber band ligation are considered as two common office procedures for haemorroids. Patients, in general, are concerned about the effectiveness, post-procedure pain and the possibility of future recurrence of a particular procedure and insist on a non-ambiguous reply from the treating surgeon. The surgeon has the moral responsibility to explain to the patient regarding the comfort and efficacy of a particular procedure. In the present study, a comparison has been made between infrared coagulation and rubber band ligation, giving greater emphasis on post-procedure discomfort and effectiveness.
Methods: One hundred five patients with second degree bleeding haemorrhoids were treated either by infrared coagulation (N = 51) or rubber band ligation (N = 54). After the procedures, parameters like pain, discomfort, relief in incidence of bleeding, time to return to work and recurrence rate were studied and compared.
Result: The mean duration of disease was 16.5 months (range: 12 to 32 months). There were 68 males and 37 females. The mean age was 42.71 years (range: 20-71 years). Post-procedure pain in the first week was greater in the rubber band ligation group (2-5 vs 0-3 on a visual analogue scale). In the rubber band ligation group, post-defecation pain and rectal tenesmus was more intense (P = 0.0059). Patients in the infrared coagulation group had a higher recurrence rate (P = 0.03) but resumed their duties earlier (2 vs 4 days, P = 0.03). Post procedure, the rubber band ligation group had more pain and discomfort, but the procedure was more effective in controlling symptoms and obliterating hemorrhoids. It was seen that rubber band ligation was more effective but more painful, while infrared coagulation was less painful, but efficacy was also lower. Therefore, it is concluded that infrared coagulation could be considered a suitable alternative office procedure for early stage haemorrhoids as this office procedure can be conveniently repeated in case of recurrence.
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