EP609 - Comparison of rubber band ligation versus haemorrhoidal artery ligation for second-degree and third-degree haemorrhoids: A systematic review and meta-analysis.

Author(s)

• AM

  Ali Mohamedahmed, MBBS, MSc, MRCS, MD

  Speciality Registrar
  University Hospitals of Derby and Burton NHS Trust
  Leicester, England, United Kingdom

  Disclosure information not submitted.

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ePoster Presenter(s)

• PT

  Pradeep Thomas, MBBS, FRCS

  Consultant of colorectal surgery
  University Hospitals of Derby and Burton NHS Trust
  Burton on Trent, England, United Kingdom

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Author(s)

• SA

  Sabry Abounozha, MBBS, MRCS

  Registrar
  Sunderland Royal Hospital
  Sunderland, England, United Kingdom

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• TS

  Tamer Saafan, MBBS, MRCS

  Registrar
  Cumberland Infirmary Hospital
  Carlisle, England, United Kingdom

  Disclosure information not submitted.
• RI

  Rashid Ibrahim, MBBS, MRCS

  Registrar
  Salford Royal Foundation Trust
  Manchester, England, United Kingdom

  Disclosure information not submitted.
• NH

  Najam Husain, MBBS,FCPS,FEBS Coloproct,FRCS,FACS

  Consultant of colorectal surgery
  University Hospitals of Derby and Burton NHS Trust
  Burton on Trent, England, United Kingdom

  Disclosure information not submitted.

Purpose/Background: With an estimated incidence of 4%, haemorrhoidal disease is a common problem worldwide, and second-degree and third-degree are considered the most common types. This systematic review investigates the outcomes of rubber band ligation (RBL) versus haemorrhoidal artery ligation (HAL) for second-degree and third-degree haemorrhoids.

Methods/Interventions: This systematic review was designed, performed, and reported as per the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions and Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA) guidelines. Literature databases, including PubMed, Cochrane, Science Direct and Google Scholar, were searched for studies comparing rubber band ligation versus haemorrhoidal artery ligation for second-degree and third-degree haemorrhoids. The primary outcome was the recurrence of haemorrhoids, while post-operative bleeding, postoperative pain, surgical site infection and success rate were the secondary outcomes. The meta-analysis was performed using RevMan version 5.4.

Results/Outcomes: The literature search and inclusion criteria identified five studies (n = 953) comparing HAL (n = 548) versus RBL (n = 405). The recurrence rate was higher in the RBL group (28.4%) compared to the HAL group (19.3%) [odd ratio (OR) 0.56, P= 0.001] (Figure 1). The two groups showed comparable results regarding postoperative pain (OR 1.12, P= 0.79), postoperative bleeding (OR 1.77, P= 0.22), and surgical site infection (Risk difference 0.00, P= 0.67). Moreover, the short-term success rate was 85.6% in HAL compared to 86.3% in RBL (P= 0.81).

Conclusion/Discussion: Rubber band ligation and haemorrhoidal artery ligation showed comparable short-term outcomes regarding symptoms treatment, post-operative bleeding and pain. However, HAL was superior in terms of recurrence rate.

Figure 1
Forest plot demonstrating a comparison of recurrence between HAL and RBL.