Comparative Study of Postoperative Complications after Rubber Band Ligation (RBL) and RBL Combined with Sclerotherapy in Treatment of Second- and Third-Degree Internal Hemorrhoids

  • Zhixian LiuEmail author
  • Xianqing Song
  • Feng Ye
Original Article


Hemorrhoid is a very common disease in surgical departments. Internal hemorrhoids of second degree or above often require surgical treatment due to the persistent bleeding and prolapse symptoms. Rubber band ligation (RBL) is the most common procedure available for hemorrhoids because of its safety, efficacy, and effectiveness. The study evaluates comparative results of postoperative complications after RBL and RBL combined with sclerotherapy. It included 300 patients having second- or third-degree internal hemorrhoids who attended the colorectal surgical department in Beilun People’s Hospital of Ningbo, China, over a period of 1 year from July 2015 to June 2016. These 300 patients were selected randomly and divided into two groups, with 150 for RBL group and 150 for RBL combined with sclerotherapy group. All the patients were asked to return to an out-patient clinic for follow-up at 1 day, 3 days, 7 days, 14 days, 2 months, and 6 months and through a telephone call every 6 months for 2 years. The data of all the patients including gender, age, postoperative pain, postoperative bleeding, the days of rubber band slippage, and postoperative recurrence were recorded. The statistical analysis of the study was done using SPSS statistical package in which we used descriptive statistics and chi-square test for the final evaluation. There was no significant difference between the two groups in postoperative pain. However, RBL combined with sclerotherapy achieves better results than RBL, less postoperative bleeding, less unexpected rubber band slippage, and less postoperative recurrence.


Hemorrhoid Rubber band ligation (RBL) Sclerotherapy Rectal bleeding Recurrence 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.


  1. 1.
    Lohsiriwat V (2015) Treatment of hemorrhoids: a coloproctologist’s view[J]. World J Gastroenterol: WJG 21(31):9245CrossRefPubMedGoogle Scholar
  2. 2.
    Yeo D, Tan KY (2014) Hemorrhoidectomy-making sense of the surgical options[J]. World J Gastroenterol: WJG 20(45):16976CrossRefPubMedGoogle Scholar
  3. 3.
    Lohsiriwat V (2012) Hemorrhoids: from basic pathophysiology to clinical management[J]. World J Gastroenterol: WJG 18(17):2009CrossRefPubMedGoogle Scholar
  4. 4.
    Sanchez C, Chinn BT (2011) Hemorrhoids[J]. Clin Colon Rectal Surg 24(01):005–013CrossRefGoogle Scholar
  5. 5.
    Agarwal N, Singh K, Sheikh P et al (2017) Executive summary - The Association of Colon & Rectal Surgeons of India (ACRSI) practice guidelines for the management of haemorrhoids—2016[J]. Indian J Surg 79(1):58–61CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sun Z, Migaly J (2016) Review of hemorrhoid disease: presentation and management[J]. Clin Colon Rectal Surg 29(1):022–029CrossRefGoogle Scholar
  7. 7.
    Song SG, Kim SH (2011) Optimal treatment of symptomatic hemorrhoids[J]. J Korean Soc Coloproctol 27(6):277–281CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Brown SR (2017) Haemorrhoids: an update on management[J]. Ther Adv Chronic Dis:204062231771395Google Scholar
  9. 9.
    Tiernan J (2012) The HubBLe trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for haemorrhoids[J]. BMC Gastroenterol 12Google Scholar
  10. 10.
    Aram OF (2016) Rubber band ligation for hemorrhoids: an office experience[J]. Indian Journal of Surgery 78(4):271–274CrossRefPubMedGoogle Scholar
  11. 11.
    Brown SR, Watson A (2016) Comments to ‘rubber band ligation versus excisional haemorrhoidectomy for haemorrhoids’.[J]. Tech Coloproctol 20(9):1–3CrossRefGoogle Scholar
  12. 12.
    Sajid MS, Bhatti MI, Caswell J, Sains P, Baig MK (2015) Local anaesthetic infiltration for the rubber band ligation of early symptomatic haemorrhoids: a systematic review and meta-analysis. Updat Surg 67:3–9CrossRefGoogle Scholar
  13. 13.
    Albuquerque A (2016) Rubber band ligation of hemorrhoids: a guide for complications[J]. World J Gastrointest Surg 8(9):614–620CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Lu LY, Zhu Y, Sun Q (2013) A retrospective analysis of short and long term efficacy of RBL for hemorrhoids.[J]. Eur Rev Med Pharmacol Sci 17(20):2827–2830PubMedGoogle Scholar
  15. 15.
    Pérez V F, Fernández F A, Arroyo S A, et al.2003 Effectiveness of rubber band ligation in haemorrhoids and factors related to relapse.[J]Google Scholar

Copyright information

© Association of Surgeons of India 2019

Authors and Affiliations

  1. 1.Proctology DepartmentBeilun People’s Hospital of NingboNingboChina
  2. 2.General Surgery DepartmentNingbo No.4 HospitalNingboChina
  3. 3.Colorectal Surgery DepartmentThe First Affiliated Hospital of Zhejiang UniversityHangzhouChina

Personalised recommendations