Abstract

BACKGROUND:
Hemorrhoids (piles) are vascular structures in the anal canal that act as cushions to aid with stool management. When bloated or irritated, they cause a problem.
OBJECTIVE:
The objective of this study is to see how effective rubber band ligation is for treating symptomatic first, second, and third degree hemorrhoids, as well as how to handle post-operative complications.
METHODOLOGY:
This is a descriptive case series study to examine the effectiveness, safety, quality of life, and outcomes of rubber band ligation (RBL) for first, second, and third-degree internal symptomatic hemorrhoids in 250 patients who presented to the outpatient clinic between August 2015 and March 2017; all underwent rubber band ligation using the Barron applicator on an outpatient basis for first, second, and third-degree internal symptomatic hemorrhoids. Anal fissures, fistulas, anticoagulant treatment, and blood disorders were all ruled out. The information was gathered from the patient's files. Patients were requested to return to the outpatient clinic for follow-up at two weeks,                       one month, and six months, as well as receive a phone call every six months for the next two years.
RESULTS:
From 250 patients, 180 were cured (72%), 130 were cured in the first session, 50 required additional sessions, and 20 patients had some complications (8%) of all cases, including one patient who only required hospitalization due to bleeding, nine patients who developed a perianal abscess that was drained under local anesthesia, and 25 patients who developed a rectal ulcer that was successfully treated with rectal sucralfate enema. Almost all of the patients were men, with the exception of seven females, and their ages ranged from 12 to 92.  
CONCLUSION:
Rubber band ligation is a simple, safe, and effective outpatient treatment for symptomatic first, second, and third-degree hemorrhoids. It contributes to a significant improvement in quality of life by reducing pain and allowing patients to return to daily activities sooner. It should also be considered the first line treatment for elderly patients or those who cannot tolerate general or spinal anesthesia. In terms of anal stricture, RBL has no effect on anorectal functioning. In grade 3 hemorrhoids, however, patients may require more than one treatment.