Release Date: July 19, 2005
SURGERY
IS FAVORED TREATMENT FOR SEVERE HEMORRHOIDS
By David Crosson, Contributing Writer
Health Behavior News Service
Surgical removal
of severe hemorrhoids is more effective in the long run than tying
them off with rubber bands, a less invasive treatment alternative,
according to a new review of studies.
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 line of treatment.
Numerous ointments are available to treat hemorrhoid symptoms but
the review says that there is “little objective evidence of
their efficacy.”
Hemorrhoid disease
is ranked first among the diseases of the rectum and large intestine.
About half the U.S. population has experienced hemorrhoids by age
50. Men are more frequently afflicted than women, and the peak incidence
of the disease occurs between the ages of 45 and 65.
Although patients
undergoing RBL spent significantly fewer days away from work than
patients subject to surgery, the reviewers say the escalating cost
of repeated RBL procedures needs to be considered before definite
conclusions are reached about the relative economic effect of the
two procedures.
The review also
made note of stapled hemorrhoidopexy as a new alternative to surgery,
indicating that its standing as a treatment alternative awaits evaluation
of the long-term results of the procedure.
Scott Thornton,
M.D., a surgeon at Bridgeport Hospital in Connecticut and an assistant
professor at Yale University School of Medicine, says that RBL involves “pain
of half the volume and duration” of surgery. He says that RBL
prompts complications in only about 1 percent of cases as compared
with surgery, which prompts complications in 5 percent to 8 percent
of cases.
“My own
view is that RBL is pretty darn effective as a first treatment option,” Thornton
says. “I’ll bet,” he adds, that if the reviewers “were
taking care of hemorrhoids of their own, they would opt for rubber
band ligation because there is a very significant amount of pain
involved with an excisional hemorrhoidectomy.”
Shanmugam V et
al. Rubber band ligation versus excisional haemorrhoidectomy for
haemorrhoids. The Cochrane Database of Systematic Reviews 2005, Issue
3
The Cochrane Collaboration
is an international nonprofit, independent organization that produces
and disseminates systematic reviews of health care interventions
and promotes the search for evidence in the form of clinical trials
and other studies of interventions. Visit http://www.cochrane.org for more information.
FOR MORE INFORMATION:
Health Behavior News Service: (202) 387-2829 or www.hbns.org.
Center for the Advancement of Health
Contact: Ira R. Allen
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202.387.2829
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