[Multiple vertical ligatures: A new approach to the treatment of haemorrhoidal disease grade III. Safety and efficacy study].
BACKGROUND
The elastic ligature is the most used method for the out-patient treatment of haemorrhoids, with excellent results in control of bleeding. However, the recurrences in prolapse vary between 15 and 40%. We propose a new method for applying the elastic ligatures.


METHODS
A total of 17 patients with grade iii haemorrhoids were chosen for the vertical ligatures (VL). The first elastic band was placed 3 to 4 cm from the pectineal line and 1 or 2 more in the root of the haemorrhoid group. Another 34 randomly selected patients were used as a control group. Data collected included, demographic details, number of bands and sessions, pain scale, complications and results. The patients were followed up at week one, week 3, and 3 months and one year after the intervention.


RESULTS
A total of 12 males and 5 females, with a median age of 46 years, were treated with VL. The median follow-up was 10 (from 8 to 19) months. A median of 3 sessions and 7 elastic bands were used, with 6 patients having moderate pain that required analgesic treatment. None of the patients needed urgent treatment for pain or bleeding. There was a complete response to bleeding in 15 patients (88.2%) and to prolapse in 14 (82.2%). Two patients required haemorrhoidectomy due to treatment failure. The measurements of therapeutic effect after one year were: number needed to treat (NNT) of 4 (95% CI, 2 to 22), for prolapse, and NNT of 4 (95% CI, 2 a 15), for bleeding.


CONCLUSIONS
Elastic ligatures could become a new treatment option for Grade iii haemorrhoids, improving control of bleeding and prolapse.
Sección de Cirugía Colorrectal, Hospital Universitario Donostia, San Sebastián, España. 943313762@terra.es
Carlos
C
Placer
José María
JM
Enriquez Navascués
Aintzane
A
Lizarazu
Nerea
N
Borda
D000328:Adult; D000368:Aged; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects / Q000379:methods*; D006484:Hemorrhoids / Q000145:classification / Q000601:surgery*; D006801:Humans; D008026:Ligation / Q000379:methods; D008297:Male; D008875:Middle Aged; D055815:Young Adult