Comparative study of hemorrhoidectomy and rubber band ligation in treatment of second and third degree hemorrhoids in kashmir.

The diagnosis of hemorrhoids is primarily based on the proctoscopic examination. The study evaluates comparative results of rubber band ligation (RBL) and hemorrhoidectomy. This study was conducted over a period of 1½ year from Jan 2003 to June 2004. It includes 100 patients having second- or third-degree primary hemorrhoids who attended surgical OPD of SMHS Hospital Srinagar, Kashmir. These 100 patients were selected randomly and divided into two groups of 50 patients each (hemorrhoidectomy group and RBL group). Each patient was subjected to sigmoidoscopy to exclude other lesion higher up in rectosigmoid. Patients of fissure, fistulae, and malignancy were excluded. All parameters were recorded and finally analysed. The statistical analysis of the study was done using SPSS statistical package in which we used descriptive statistics and correlation analysis for the final evaluation. Hemorrhoidectomy and RBL are equally effective especially in second-degree hemorrhoids. However, RBL should be considered the first-line treatment in second-degree hemorrhoids because being an outpatient procedure, it is cost effective for the patients, saves many a hospital beds for more sick patients, and takes the pressure off the surgical waiting list. Although RBL is not as effective as hemorrhoidectomy in third-degree hemorrhoid, it does improve bleeding and prolapse and is highly recommended for patients who are unfit for surgery or have concurrent disease that contraindicates anesthesia. RBL should be considered as the first-line treatment for second-degree hemorrhoid. However, in the third-degree hemorrhoids, hemorrhoidectomy achieves better results, and RBL is recommend as the first-line treatment for those patients in whom there is contraindication for surgery or anesthesia.