A comprehensive randomised controlled trial conducted between 2012 and 2014, known as the HuBBLe trial, has provided valuable insights into the comparative efficacy of two standard surgical interventions for hemorrhoidal disease: rubber band ligation (RBL) and hemorrhoidal artery ligation (HAL).
Led by Professor Steven Brown and coordinated through the Sheffield Clinical Trials Research Unit, the study enrolled 372 patients across the UK to evaluate outcomes pertinent to clinical decision-making.
At one-year follow-up, recurrence rates were significantly different, with 49% of patients in the RBL cohort experiencing symptom recurrence compared to 30% in the HAL group.
Additionally, about one-third of RBL patients with persistent symptoms required further treatment, but there was little difference between the two groups in terms of symptom return timelines.
In terms of patient experience, those undergoing HAL reported more pain than RBL patients.
Despite this, symptom scores, quality of life, continence, and complications were similar across treatments.
Cost analysis showed HAL to be significantly more expensive than RBL.
The trial's findings, published in The Lancet, have already influenced health policy in the UK, US and Europe.
They have encouraged surgeons to favour the less painful and more cost-effective RBL, with current NHS guidance in the UK recommending that patients should try rubber band ligation before considering surgical intervention.
Professor Brown said: ‘HuBBLe has influenced the management of haemorrhoids through greater awareness of cost efficacy. Some surgeons and centres have moved to recommending a course of rubber band ligation rather than surgical intervention for certain patients. Current NHS guidance stresses the need for this group to have failed rubber band ligation before undergoing intervention.’
