The review found no significant difference in patients' acceptance of each technique, "implying patients' preference for complete long-term cure of symptoms" despite the pain and higher risk of complications following surgery.
Rubber band ligation, or RBL, involves a rubber band placed around the base of the hemorrhoid, cutting off circulation, causing the hemorrhoid to wither away, generally within two weeks. This procedure had a success rate ranging from 69 percent to 94 percent, the study found, and was equal to surgery in terms of relieving the most common symptoms. However, surgery "achieved better overall cure rate" because patients undergoing RBL were more likely to need future treatment.
The review appears in the July issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
Lead researcher Venkatesh Shanmugam of the Aberdeen Royal Infirmary of Aberdeen University in Scotland says that the study was done because none of the usual treatments -- diet change, rubber bands or surgery -- had previously been identified as better. This review involved 206 patients in three different studies.
Hemorrhoids are classified by degree of severity, with fourth degree the worst. The review suggests that surgery might be adopted as a treatment of choice for hemorrhoids classified as third or fourth degree and those that re-occur after RBL, and that RBL might be adopted as a treatment of choice for first- or second-degree hemorrhoids.
Dietary adjustments and bulk-forming agents generally are the first
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Contact: Venkatesh Shanmugam
venki411@yahoo.co.uk
Center for the Advancement of Health
19-Jul-2005