Infrared Coagulation versus Rubber Band Ligation in Early Hemorrhoids; PAIN VS GAIN.

The ideal therapy for early degrees of hemorrhoids is always debated. Some are more effective but are more painful, others are less painful but the efficacy is in the same proportion. So pain or gain is a major concern. In this randomized study, a comparison is made between infrared coagulation and rubber band liagation. One hundred patients of 2nd degree bleeding piles were randomized prospectively to either band ligation or infrared coagulation technique. Parameters measured included postoperative discomfort and pain, period for return to work, relief in incidence of bleeding and recurrence rate. The patient demographic was comparable in two groups. The postoperative pain in the first week was more in band ligation group (2-5 versus 0-3 on visual analogue scale). The post defecation pain was more with band ligation and so was rectal tenesmus (p=0.0059). The patients from the infrared coagulation group resumed their duties early (2 versus 4 days, p= 0.03). However, recurrence or failure rate was higher with the infrared coagulation group than the rubber band ligation group (p= 0.03). The study shows that band ligation is more effective (P= 0.0019) in controlling symptoms and obliterating hemorrhoids; it is associated with more pain (p=0.0035) and discomfort to the patient. As the infrared coagulation can be conveniently repeated in case of recurrence, it should be considered as the first line of therapy in early hemorrhoids.