Clinical Evaluation of Modified Band Ligation for Treating Second-Degree Hemorrhoids in A Tertiary Care Centre

Background: Hemorrhoids are a common anorectal disorder affecting a large proportion of adult male population, and sometimes are associated with non- painful bleeding and prolapsus on defecation (second degree). One of the commonly used minimally invasive therapeutic modalities is rubber band ligation (RBL). Band ligation procedures have been modified to enhance their efficacy, reduce their recurrence and minimize problems. This study aims to assess the efficacy and safety of the modified band ligation procedure in cases of second degree and higher hemorrhoids. Material and Methods: The materials and methods involved in this were a prospective observational study which continued for a 10-month period, including 55 patients with second-degree hemorrhoids at the department of General Surgery, a tertiary care hospital. The modified band ligation was performed in both groups of participants according to standard protocol. Demographic data, clinical presentation, surgical findings and early and late postoperative complication rates were collected. The patients' responses were measured in terms of pain, bleeding, recurrence, complications, and satisfaction. Follow-up assessment occurred 1, 1, 3, and 6 months after the procedure. Appropriate statistics were used to analyze the data and the P value< 0.05 was the significant value. Results: Of 55 patients, who were mainly male (60%), the mean age was 42.3 ± 11.5 years. Painless rectal hemorrhage (87%) was the most common presenting symptom followed by intermittent prolapse during feces (60%). In all patients, modified band ligation was performed successfully, in the mean time of 8 ± 2 minutes. There was moderate and brief postoperative pain in 45 (82%) patients and only 10 (18%) required analgesics for more than 48 hours. There were minor complications, which included bleeding that resolved spontaneously in 7 patients (12.7%) and urine retention in 2 patients (3.6%). No serious complications such as severe pain, septic or thrombosed hemorrhoids were reported. Of the 3 (5.4%) patients who did recur at the 6-month follow-up, they were successfully treated with repeat band ligation. Patient satisfaction was high at 90%, from good to outstanding. Conclusion: Modified band ligation is safe, effective, and minimally invasive treatment of 2nd degree hemorrhoids. It has high patient satisfaction, fewer complications and a low recurrence rate. It offers an alternative practical outpatient procedure alternative for patients who wish for rapid recovery, and a reduced procedural morbidity.

Keywords: Hemorrhoids, Modified Band Ligation, Outpatient Procedure, Rubber Band Ligation, Treatment.