DOI: 10.1177/00031348261474195 ISSN: 0003-1348

Suture Reinforcement of Rubber Band Ligation for Internal Hemorrhoids: A Technical Modification to Reduce Delayed Massive Bleeding

Haibin Wu, Wenxin Shen, Zecheng Zhang, Yi Zhang
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Background

Rubber band ligation (RBL) is a widely accepted treatment for Grade II–III internal hemorrhoids. However, postoperative bleeding, particularly delayed massive bleeding (DMB), remains a serious complication. This study aims to compare the outcomes of RBL alone vs RBL combined with absorbable suture ligation (RBL-SL), with a primary focus on postoperative DMB events.

Methods

We retrospectively enrolled patients with grade II/III internal hemorrhoids who were treated with RBL from May 2024 to December 2024 and RBL combined with suture ligation from January 2025 to July 2025 at the General Hospital of Central Theater Command. The incidence of DMB and hemorrhoids recurrence were evaluated as the primary outcomes. The secondary outcomes assessed were the degree of postoperative pain, anal edema, and sensation of prolapse. The Hemorrhoidal Disease Symptom Score (HDSS) and Short Health Scale for HD (SHS-HD) were documented during long-term follow-up.

Results

A total of 530 patients were enrolled, including 263 patients received RBL combined with suture ligation and 267 patients underwent RBL alone. There was no statistically significant difference in most baseline characteristics except age and body mass index (BMI) between the two groups ( P > 0.05). Compared with one patient who underwent DMB in the RBL-SL group, seven cases of DMB were observed in the RBL group. The difference was statistically significant ( P < 0.05). Although the number of hemorrhoid recurrence cases in the RBL-SL group was lower than the RBL group, there was no statistically significant difference in the recurrence rate between the two groups (8.0% vs 12.7%, P > 0.05). On the third and seventh days after surgery, there were no statistically significant differences in minor complications (pain score, anal edema, and prolapse sensation) between the two groups( P > 0.05). There were also no significant differences in HDSS and SHS scores between the two groups after surgery ( P > 0.05).

Conclusion

In this single-center, nonrandomized study, adjunctive absorbable suture ligation was associated with a signal toward reduced DMB after RBL for internal hemorrhoids. However, due to the small number of events, wide confidence intervals, and potential for bias from sequential allocation, these findings are hypothesis-generating only. Further prospective, randomized evaluation is required before considering this technique as a new standard of care.

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