Efficacy and safety of combined endoscopic rubber band ligation in the treatment of grade II-III prolapsed hemorrhoids: a retrospective study (with video)

Background Hemorrhoids is one of the most common anorectal diseases. In recent years, the incidence rate of hemorrhoids has been rising. Aims To investigate the efficacy and safety of combined endoscopic rubber band ligation (ERBL) in the treatment of grade II-III prolapsed internal hemorrhoids. Methods Patients with grade II-III prolapsed internal hemorrhoids treated from January 2019 to June 2023 were reviewed. Results Complete resolution was achieved in 124 cases (91.85%), partial resolution in 7 cases (5.19%), and recurrence in 4 cases (2.96%). 34 (25.19%) cases experienced anal pain after procedure, with a median visual analog scale (VAS) score of 0 (0–3). Postoperative bleeding occurred in 18 (13.33%) cases. Anal swelling was observed in 19 (14.07%) cases, and urinary retention occurred in 4 cases (2.96%). The incidence of postoperative pain (30.43% vs. 11.6%, P = 0.018) and VAS scores (0 vs. 0, P = 0.003) in the ligate three hemorrhoids group were significantly higher compared to the ligate two hemorrhoids group. There was no significant difference in long-term efficacy between the two groups. Male [odds ratio (OR) 5.654, 95% confidence interval (CI) 1.222–26.159; P = 0.027] and postoperative complications (OR 4.914, 95% CI 1.080–22.345; P = 0.039) were independent risk factors that were incomplete resolution. Conclusions Combined ERBL is an efficient and safe method for grade II-III prolapsed internal hemorrhoids. The number of hemorrhoids ligated had no significant effect on the long-term outcome, but the ligation of three hemorrhoids was associated with an increased incidence of postoperative pain. Male and postoperative complications are risk factors for incomplete resolution.