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| 번호 | 제목 | 등록일 | 조회수 |
|---|---|---|---|
| 118 | Short-Term and Long-Term Results of Combined Sclerotherapy and Rubber Band Ligation of Hemorrhoids and Mucosal Prolapse [2003년 9월 DCR] | 2011-11-17 | 3523 |
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Simon S. B. Chew, F.R.A.C.S.,* Lynne Marshall, Assoc. Dip. M.R.A.,*Larry Kalish, M.B.B.S.,* Jui Tham, M.B.B.S.,*David A. Grieve, M.Med.(Cl. Epid.), F.R.A.C.S.,† Philip R. Douglas, F.R.A.C.S.,*
Graham L. Newstead, F.R.A.C.S.* From the *Colorectal Unit, †Department of Surgery, Prince of Wales Hospital, Sydney, Australia PURPOSE: Rubber band ligation is a common office procedure for symptomatic hemorrhoids. The aim of the study was to assess our short-term and long-term results of combined sclerotherapy and rubber band ligation in the management of hemorrhoids and incomplete mucosal prolapse.
METHODS: Data on 6,739 patients who had previous combined sclerotherapy and rubber band ligation by the senior authors (GLN and PRD) were retrieved from the database dating between January 1976 and June 2000. These patients either had hemorrhoids or incomplete mucosal prolapse. Furthermore, questionnaires were sent to a random sample of 2,400 patients. Telephone interviews were performed for 600 of the nonrespondents. RESULTS: Of 6,739 patients (3,683 males; mean age, 46.7 years) in the database, 4,686 (70 percent) received the procedure once, and 2,053 (30 percent) received the procedure more than once. There were 5,689 patients (84 percent) who had their procedures performed consecutively within a planned period, and only 1,050 patients (16 percent) had repeat procedures after a period of more than 12 months from their last treatments. Thus, the recurrence rate was 16 percent. The overall complication rate was 3.1 percent, with minor bleeding being the major complaint. With regard to the questionnaire, 44 percent responded. The mean follow-up period was 6.5 (range, 1–11) years. There were patients who had
residual symptoms of bleeding (19 percent), itch (21 percent), and lump (20 percent). However, 58 percent of patients who replied were asymptomatic. With satisfaction scores ranging from +3 to -3 (+3 indicating complete satisfaction and -3 indicating complete dissatisfaction), 90 percent scored >/= 1, 9 percent scored 0 or less, and 1 percent did not specify a score. Hemorrhoidectomy was required in 7.7 percent of the responders. Of 600 phone interviews with the nonrespondents, 152 responded to the questionnaires. Although there was less satisfaction from the phone respondents, which may have accounted for the initial nonresponse, no statistical difference was detected in residual symptoms. CONCLUSIONS: Combined triple sclerotherapy and rubber band ligation is an effective treatment
for early hemorrhoids and incomplete mucosal prolapse, with low rates of recurrence, complications, and hemorrhoidectomy, and it can be repeated easily. Rubber band ligation has been recognized as a technique for symptomatic early hemorrhoids since Barron’s first description in 1963. Many studies have demonstrated short-term and long-term success,
with low morbidity. Moreover, patient satisfaction has been shown to be high, as in a three-year review by Steinberg et al., who found that 89 percent of patients were happy with the results. Sclerotherapy has also been used for a long time but has been found to be inferior to rubber band ligation in terms of response to treatment and recurrence rate. The senior author (GLN) introduced the concept of combined sclerotherapy and rubber band ligation 25 years ago, its rationale being to create a soft, deformable bulge with the sclerosant, thus allowing the bands to hold well and ensuring the sclerosant is placed at the base of the hemorrhoid. The primary purpose is therefore for technical ease, and the clinical benefit of using sclerotherapy (or not) in association with banding, particularly with regard to its potential in reducing the incidence of secondary hemorrhage, has not been the subject of a controlled trial in this series. The aim of the present study was to present the short-term and long-term results of combined sclerotherapy and rubber band ligation in the management of early hemorrhoids and incomplete mucosal prolapse in a large database. |
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