For severe hemorrhoids surgery is best

According to a review of previous studies, regarding the treatment of severe hemorrhoids,surgical removal is the treatment of choice.

For less severe hemorrhoid disease, circling the hemorrhoid with a tiny rubber band, known as rubber band ligation (RBL), is often adequate.

This procedure cuts off the blood supply to the hemorrhoid, so that it eventually drops off.

In their study Dr. V. Shanmugam, from Aberdeen University in Scotland, and colleagues, searched various medical databases, for trials that compared RBL and surgical removal as treatment for hemorrhoids.

Although they identified in excess of 700 studies in the search of these databases, just three trials were considered reliable enough to include in the analysis.

Their overall analysis suggested that hemorrhoid symptoms were 68 percent more likely to resolve with surgery than with RBL, and further analysis showed in fact that surgery was indeed better than RBL at resolving severe hemorrhoids.

When it came to resolving less severe hemorrhoids, the two forms of therapy were found to be comparable, although patients treated with surgery were less likely to require repeat treatments in the future.

As the team expected, surgical removal was associated with significantly greater postoperative pain than RBL, and minor complications, although fairly rare, were more common with surgery than with RBL.

Patients who had surgery also missed more days of work after the procedure.

Despite the increase in pain and complications seen with surgery, the researchers found that patient satisfaction and patient's acceptance of the treatment effects appeared to be similar following both the techniques.

This say the authors implies patients are more concerned about complete long-term resolution of symptoms and possibly less concerned about minor complications.

They say the results support the use of surgery for severe hemorrhoids and RBL for less severe disease, but "more robust study is required to make definitive conclusions".

The study is published by The Cochrane Library, July 2005.

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