Randomised controlled trial comparing rubber band ligation with stapled haemorrhoidopexy for Grade II circumferential haemorrhoids: Long-term results

V. Shanmugam, G. Muthukumarasamy, Jonathan Alistair Cook, Luke David Vale, Angus Watson, M. A. Loudon

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Objective An improved understanding of the pathophysiology of haemorrhoids has resulted in the introduction of new surgical techniques including stapled haemorrhoidopexy (SH). This randomized controlled trial compared the long-term effectiveness of SH with rubber band ligation (RBL) in the treatment of grade II circumferential symptomatic haemorrhoids.

Method A consecutive cohort of patients was randomly allocated to either SH or RBL. Data on haemorrhoidal symptoms, Cleveland continence scores, sphincter assessment, SF-36, EQ-5D, HAD score and prior treatment history were assessed at enrolment and reassessed by long-term postal questionnaire. The details were analysed using spssTM 12.0 from MicrosoftTM Access®.

Results Sixty patients were allocated by computer block randomization. Both groups were balanced for age, sex and symptoms. Recurrence favoured SH [3 vs 11; OR 0.18, 95% CI (0.03 to 0.86), P = 0.028] at 1 year and, at a mean of 40.67 (31–47) months [4 vs 12; OR 0.23, 95% CI (0.05, 0.95); P = 0.039]. SH patients experienced prolonged pain [Median (IQR) = 7 (5,7) vs 3 (1,7), P = 0.008] and took a longer time to return to work [6 (3,7) vs 3 (1,6) days, P = 0.018]. This was no significant difference in quality of life.

Conclusion Stapled haemorrhoidopexy achieved better disease control at 1 year without any major complication. This was sustained in the long-term. Further studies with greater patient numbers are needed to confirm this study.
Original languageEnglish
Pages (from-to)579-586
Number of pages8
JournalColorectal Disease
Issue number6
Early online date27 Mar 2009
Publication statusPublished - Jun 2010



  • haemorrhoids
  • stapled haemorrhoidopexy
  • rubber band ligation
  • randomized controlled trial

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