G. P. Poon

Conventional vs. triple rubber band ligation for hemorrhoids. A prospective, randomized trial.

Two hundred five patients with symptomatic first- and second-degree hemorrhoids were randomized to receive either conventional rubber band ligation or triple rubber band ligation. In conventional rubber band ligation, the hemorrhoids were ligated at one primary site per session at intervals of four weeks until symptoms were relieved or when all three hemorrhoids were ligated. In triple rubber band ligation, all three primary hemorrhoids were ligated in a single session. After completion of treatment, the patients were examined every three months, or earlier if symptoms recurred. Both methods were effective in the treatment of early hemorrhoids and the incidence of postligation pain and complications was similar. The advantages of having the treatment completed at the initial visit in triple rubber band ligation are obvious. Furthermore, less treatment sessions were required for triple rubber band ligation to control symptoms than for conventional rubber band ligation. Triple rubber band ligation is more cost-effective and therefore is recommended.

Rubber band ligation of three primary hemorrhoids in a single session

Rubber band ligation was used in 221 patients with first or second-degree hemorrhoids. All three primary hemorrhoids were ligated at a single out-patient session without anesthesia. Nineteen patients were lost to follow up. For the 202 patients under review, the follow up period ranged from three to 39 months with a mean of 18.4 months and median of 17 months. Excellent or good results were obtained in 183 patients (90.6 per cent). Moderate to severe pain was noticed by 58 patients (28.7 per cent). Further banding was required in 28 patients (13.9 per cent) and hemorrhoidectomy in six patients (3 per cent). The overall complication rate resulting from the treatment procedure was 3.5 per cent.

Prophylaxis of post-appendicectomy sepsis by metronidazole and ampicillin: A randomized, prospective and double-blind trial

Two hundred and eighty‐three patients were admitted to a randomized, prospective and double‐blind trial of the effect of the addition of ampicillin to metronidazole in the prophylaxis of post‐appendicectomy wound sepsis. Nineteen out of 142 patients in the metronidazole and ampicillin group developed wound sepsis compared with 33 out of 141 patients in the metronidazole group. The difference is statistically significant. Early cases, including normal, acutely inflamed and gangrenous appendices, received 2 doses of antibiotics. In late cases with perforation and abscess formation, the antibiotics were continued for 1 week. The difference in wound infection in each of these 2 subgroups was also statistically significant. The commonest organisms isolated from the appendicular fossa and the infected wounds were Escherichia coli and Bacteroides fragilis.

Conventionalvs. Triple rubber band ligation for hemorrhoids

Two hundred five patients with symptomatic first- and second-degree hemorrhoids were randomized to receive either conventional rubber band ligation or triple rubber band ligation. In conventional rubber band ligation, the hemorrhoids were ligated at one primary site per session at intervals of four weeks until symptoms were relieved or when all three hemorrhoids were ligated. In triple rubber band ligation, all three primary hemorrhoids were ligated in a single session. After completion of treatment, the patients were examined every three months, or earlier if symptoms recurred. Both methods were effective in the treatment of early hemorrhoids and the incidence of postligation pain and complications was similar. The advantages of having the treatment completed at the initial visit in triple rubber band ligation are obvious. Furthermore, less treatment sessions were required for triple rubber band ligation to control symptoms than for conventional rubber band ligation. Triple rubber band ligation is more cost-effective and therefore is recommended.

The treatment of urinary tuberculosis.

During the last 7 years we treated 92 patients with tuberculosis of the urinary tract. Patients with tuberculous infection were divided into 3 groups according to treatment: group 1--no surgical treatment (18 patients), group 2--ablative surgery (45 patients) and group 3--reconstructive surgery (29 patients). Antituberculous drugs, consisting of rifampin, pyrazinamide, isoniazid and ethambutol, were given according to the severity and extent of the infection process. The results of medical and surgical treatment were most gratifying. Surgical morbidity was low and there was no immediate mortality.