title: Prospective randomized clinical trial on suction elastic band ligator versus forceps ligator in the treatment of haemorrhoids.
abstract: OBJECTIVE
  This prospective randomized clinical trial was undertaken to compare the use of a single-operator vacuum suction ligator and the traditional forceps ligator in terms of pain perception following the procedure, intra-procedure bleeding and other complications.
  
  
  METHODS
  One hundred consecutive patients with second- and third-degree haemorrhoids presenting between July 2002 and September 2003 were randomized into suction and forceps groups for rubber band ligations. They were equally distributed in both groups, with a mean age of 48.7 years (range, 15-83 years). The immediate, 24-hour, 7-day and 14-day pain scores after the procedure were evaluated using a visual analogue scale. Intra-procedure bleeding and other complications at follow-up were evaluated.
  
  
  RESULTS
  Pain perception was worse in the forceps group immediately after ligation, with a mean score of 6.08 compared with 3.08 in the suction group (p < 0.001). Pain score remained high among the forceps patients at 24 hours post-banding, with a mean score of 4.00 compared with 1.92 in the suction group (p < 0.001). There was no significant difference in terms of immediate and 24-hour pain perceptions whether two or three haemorrhoids were banded per session (p = 0.904 and p = 0.058). The amount of analgesia consumed after banding correlated well with the severity of pain reported, being higher among the forceps group with a mean of 4.48 tablets (p = 0.003). Intra-procedure bleeding occurred in 25 patients in the forceps group compared with five in the suction group (p < 0.001). There were no severe complications such as perianal sepsis, urinary retention, sphincter dysfunction or bleeding during the trial.
  
  
  CONCLUSIONS
  Suction band ligation is superior to forceps ligation for the treatment of second- and third-degree haemorrhoids in terms of pain tolerance, amount of analgesia consumed and intra-procedure bleeding.
authors.affiliation: Department of Surgery, Hospital Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur, Malaysia. ramzisham@hotmail.com
authors.forename: A R Mohd
authors.initials: AR
authors.lastname: Ramzisham
authors.forename: Ismail
authors.initials: I
authors.lastname: Sagap
authors.forename: Sukumar
authors.initials: S
authors.lastname: Nadeson
authors.forename: Ismail M
authors.initials: IM
authors.lastname: Ali
authors.forename: Mohd J
authors.initials: MJ
authors.lastname: Hasni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications; D011446:Prospective Studies; D013396:Suction; D013514:Surgical Procedures, Operative / Q000379:methods*; D016896:Treatment Outcome