Endoscopic band ligation of internal haemorrhoids versus stapled haemorrhoidopexy in patients with portal hypertension |
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| Authors: | Tarik Zaher Islam Ibrahim Amany Ibrahim |
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| Institution: | 1. Gastrointestinal Endoscopy Unit, Endemic and Tropical Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt;2. General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt;3. Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt;1. Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA;2. Department of Public Health and Community Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt;3. Department of Obstetrics and Gynaecology, Faculty of Medicine, Cairo University, Cairo, Egypt;4. Department of Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt;5. Division of Infectious Diseases, Department of Pediatrics, University of North Carolina at Chapel Hill School of Medicine, NC, USA;1. Multispecialistic Rectal-Perineal Disease Centre, “Sacro Cuore,” Don Calabria Hospital, Negrar, Verona, Italy;2. Department of Anaesthetic and Surgical Sciences, University of Verona, Policlinico G.B., Rossi, Piazzale L.A., Scuro n. 1, 37134 Verona, Italy;3. Department of Surgery, “Casa di cura San Francesco” Hospital, Verona, Italy;1. Clinical Pathology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt;2. Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt;3. Internal Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt |
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| Abstract: | Background and study aimPortal hypertension is common in Egypt as a sequela to the high prevalence of hepatitis C virus and bilharziasis. In portal hypertension internal haemorrhoids are frequently found. The aim of this work was to compare the outcome of endoscopic band ligation (EBL) of symptomatic internal haemorrhoids with that of stapled haemorrhoidopexy (SH) in Egyptian patients with portal hypertension.Patients and methodsIn this study, 26 portal hypertensive patients (with oesophageal and/or fundal varices) with a grade 2–4 internal haemorrhoids who had no coagulation disorders were randomised to treatment by EBL (13 patients) or SH (13 patients) after doing colonoscopy. Symptom scores of bleeding and prolapse were assessed before and after the intervention. Complications were recorded. Patients were followed up for 12 months.ResultsGoligher’s grades of internal haemorrhoids improved significantly (p = 0.018) 12 weeks after SH (from 2.9 ± 0.8 to 0.4 ± 0.5; p = 0.001) and after EBL (from 2.8 ± 0.8 to 1.1 ± 0.8; p = 0.001). Symptom (bleeding and prolapse) scores significantly improved 4 weeks after both EBL (from 1.6 ± 0.8 to 0.6 ± 0.8; p < 0.001 and from 1.6 ± 0.9 to 0.5 ± 0.5; p = 0.002, respectively) and SH (from 1.8 ± 0.8 to 0.2 ± 0.4; p = 0.002 and from 1.5 ± 0.9 to 0.2 ± 0.4; p = 0.001, respectively). The differences after 4 weeks between EBL and SH were not significant (p = 0.168 and p = 0.225). Pain requiring analgesics occurred in five patients (38.5%) after EBL, compared with six (46.2%) after SH (p = 0.691). Minimal bleeding occurred in two patients (15.4%) after EBL but not with SH; urinary retention was observed in one patient after EBL compared with two after SH; and anal fissures were observed in one patient after EBL. During 1-year follow-up, increased frequency of stool occurred in one patient after EBL. Recurrence of symptoms was observed in three patients after EBL and in one after SH.ConclusionFor portal hypertensive patients with internal haemorrhoids and without coagulation disorders SH seems to be superior to EBL. However further studies are needed to evaluate EBL in different grades of cirrhosis. |
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