Our Summary

This research paper looks at how effective two different treatments for severe hemorrhoids (grade III) are: rubber band ligation (RBL) and hemorrhoidectomy (surgical removal). The researchers looked back at patient records from January 2013 to August 2018. They were interested in the patients’ symptoms, whether they needed more treatment, any complications, and how the patients reported their outcome.

The study included 327 patients. Treatment was chosen based on how bad the symptoms were and what the patient preferred. The most common symptoms were prolapse (the hemorrhoid sticking out) and blood loss. Hemorrhoidectomy worked as a single procedure in 96% of cases, while a single RBL treatment was only effective in 52% of cases. About 35% of the RBL group had to have a second RBL treatment.

Complications were not significantly different overall, but 4 patients developed fistulas (abnormal connections between organs) after hemorrhoidectomy, and none after RBL. Patient-reported outcomes were similar for both treatments. The main takeaway is that treating severe hemorrhoids usually takes more than one RBL treatment, while one hemorrhoidectomy is usually enough. However, complications were more common after hemorrhoidectomy.

FAQs

  1. How effective was the rubber band ligation (RBL) treatment for severe hemorrhoids compared to the hemorrhoidectomy?
  2. What were the most common complications after the two different treatments for severe hemorrhoids?
  3. What percentage of patients required a second RBL treatment for their severe hemorrhoids?

Doctor’s Tip

One helpful tip a doctor might tell a patient about hemorrhoidectomy is to expect some discomfort and pain during the recovery period. It is important to follow the doctor’s post-operative care instructions, such as taking prescribed pain medication, keeping the area clean, and avoiding strenuous activities. It is also important to eat a high-fiber diet, stay hydrated, and avoid straining during bowel movements to prevent recurrence of hemorrhoids. If any unusual symptoms or complications arise, it is important to contact the doctor immediately.

Suitable For

Patients who are typically recommended for hemorrhoidectomy are those with severe hemorrhoids (grade III or IV) who have not responded to non-surgical treatments such as dietary changes, topical treatments, or rubber band ligation. Patients who have persistent symptoms such as prolapse, significant bleeding, or those with large external hemorrhoids may also be recommended for hemorrhoidectomy. Additionally, patients who have tried other treatments but continue to have recurrent hemorrhoids may also be candidates for hemorrhoidectomy.

Timeline

Before hemorrhoidectomy, a patient may experience symptoms such as prolapse and blood loss. They may have tried conservative treatments such as dietary changes and topical medications without success. The decision to undergo surgery is usually made based on the severity of symptoms and the patient’s preference.

After hemorrhoidectomy, the patient will experience some pain and discomfort, which can be managed with pain medication. They will also need to follow post-operative care instructions, including taking sitz baths and avoiding straining during bowel movements. The recovery period can take a few weeks, during which time the patient may need to take time off work and limit physical activity.

Overall, the research suggests that hemorrhoidectomy is more effective as a single procedure for severe hemorrhoids compared to rubber band ligation. However, complications such as fistulas can occur after hemorrhoidectomy, while RBL may require multiple treatments for success. Patient-reported outcomes were similar for both treatments, indicating that both can provide relief from symptoms of severe hemorrhoids.

What to Ask Your Doctor

Questions a patient should ask their doctor about hemorrhoidectomy include:

  1. What are the potential risks and complications associated with a hemorrhoidectomy?
  2. How effective is a hemorrhoidectomy compared to other treatment options, such as rubber band ligation?
  3. What is the recovery process like after a hemorrhoidectomy?
  4. Are there any long-term effects or considerations to be aware of after undergoing a hemorrhoidectomy?
  5. How soon can I expect relief from my symptoms after a hemorrhoidectomy?
  6. Will I need to make any changes to my diet or lifestyle after the procedure?
  7. What can I do to prevent hemorrhoids from recurring in the future?
  8. Are there any alternative treatments or therapies that I should consider before deciding on a hemorrhoidectomy?
  9. How many hemorrhoidectomies have you performed, and what is your success rate?
  10. How will my symptoms be monitored and managed after the procedure?

Reference

Authors: Dekker L, Bak MTJ, Bemelman WA, Felt-Bersma RJF, Han-Geurts IJM. Journal: Ann Coloproctol. 2022 Apr;38(2):146-152. doi: 10.3393/ac.2020.01011.0144. Epub 2021 Jul 27. PMID: 34314581