Kleinübing H Jr et al. (2006) Longitudinal multiple rubber band ligation: an alternative method to treat mucosal prolapse of the anterior rectal wall. Dis Colon Rectum 49: 876–878

There is controversy over which treatment for mucosal prolapse of the anterior rectal wall provides the longest complete remission from symptoms. Kleinübing et al. have carried out a preliminary, single-center study into the use of multiple, longitudinally sited, rubber-band ligation. Their results indicate that this treatment could be a valuable alternative to standard care.

All treated patients had proctoscopy-confirmed mucosal prolapse, and had not responded to conservative treatment of their symptoms (bulk laxatives and advice on bowel habits). Double (7 patients) or triple (9 patients) rubber-band ligation was performed, depending on the extent of prolapsed mucosa. No sedation or antibiotics were required, although oral NSAIDs and paracetamol were prescribed.

Complete and persistent remission of symptoms was reported by 14 patients at telephone follow-up (median 12 months, range 9–15 months). Of the two symptomatic patients, one was successfully treated by repeat ligation. This procedure was unsuccessful in the other patient, who was subsequently diagnosed with complete internal rectal prolapse by defecography. This patient was the only participant to report procedure-related complications (persistent pain for 7 days post-treatment).

The authors graded pretreatment prolapse severity according to the Pescatori and Quonamcarlo scheme, but this failed to identify the patient with complete rectal prolapse. They recommend, therefore, that defecography should be performed before rubber-band ligation to identify patients who might benefit. Further studies with larger patient groups and longer follow-up, and which directly compare this treatment with standard care, are now needed.