Surgery Versus Flexible Endoscopic Rubber Band Ligation for Grade 2 and 3 Internal Hemorrhoids

Abstract

Surgery has traditionally been the primary treatment for symptomatic internal hemorrhoids. However, office-based interventions such as rubber band ligation (RBL) are increasingly used for Grades 1–3 hemorrhoids. Flexible endoscopic RBL offers a minimally invasive alternative, whereas surgery remains standard for Grade 4. To compare the effectiveness of flexible endoscopic RBL versus surgical hemorrhoidectomy in managing symptomatic Grades 1–3 internal hemorrhoids, focusing on bleeding control, pain, recovery time, and recurrence. A comparative study of 55 patients treated with flexible endoscopic RBL (using Olympus kits) and 55 matched patients undergoing conventional excisional hemorrhoidectomy (open technique). Patients choose their treatment after counseling. Outcomes were assessed over 1 year, with follow-up at 1 week, 3, 6, and 12 months. Pain was measured using a Visual Analog Scale (≥4 defined significant pain). Statistical analysis used a statistical package for the social sciences v26 (t-tests for continuous variables, Chi-square for categorical; P < 0.05 significant). Both groups showed comparable efficacy: Bleeding control (95% vs. 93%), mucosal prolapse resolution (96% vs. 97%), and 1-year recurrence (30% vs. 29%). RBL had superior post-procedural outcomes: Lower pain (10% vs. 90%), fewer work absences (5% vs. 95%), and no bed-boundness (0% vs. 100%; all P < 0.05). Flexible endoscopic RBL is as effective as surgery for Grades 1–3 hemorrhoids but significantly reduces pain, recovery time, and work absenteeism. RBL should be considered a first-line option for eligible patients.