Aim: This study is a critical review of conservative office treatments of haemorrhoidal disease.
Material of study: Many are outpatient techniques proposed in current literature; several with small series, anecdotal ones or some ones yet abandoned for excessive morbidity (for example anal divulsion, dilatation and so on); among most used we describe procedure, indications, contraindications, results and limits about rubber band ligation, sclerotherapy, cryotherapy, infrared photocoagulation, bipolar diathermy and direct current therapy.
Results: Each method has its supporters, indications and limits; therefore in literature there are discordant opinions even when randomized studies are compared. Indeed each technique is been compared with one or more other ones but there is not a randomized trial which compares all these treatments.
Conclusions: Conservative office techniques, and rubber band ligation in particular, have an important role in second degree haemorrhoidal disease, in non-responsive to medical treatment first degree and also in third degree haemorrhoids in elderly patients with comorbidity or with sectorial or moderate prolapse.