A 42-year-old woman has second degree haemorrhoids that prolapse on defecation and reduce spontaneously. After failure of conservative measures, which procedure is most appropriate?
- A Rubber band ligation ✓
- B Excisional haemorrhoidectomy
- C Stapled haemorrhoidopexy as first choice over all other options
- D Injection sclerotherapy with phenol in almond oil
Correct answer: A. Rubber band ligation
Explanation
Goligher grade I and II haemorrhoids respond to injection sclerotherapy and banding respectively; grade III (prolapse requiring manual reduction) is classically treated with rubber band ligation or stapled haemorrhoidopexy before resorting to excisional haemorrhoidectomy, which is reserved mainly for grade IV or circumferential disease because of greater pain and complications. Banding is office based, well tolerated, and effective for grade III disease that has failed conservative measures.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.