What is the procedure for rubber band ligation (RBL) of hemorrhoids and do the bands remain in place?

From the Guidelines

Hemorrhoid banding, also known as rubber band ligation, is a highly effective treatment for internal hemorrhoids, where a small rubber band is placed around the base of the hemorrhoid, cutting off its blood supply, and the band along with the treated tissue naturally falls off within 1-2 weeks. The procedure is typically performed in a doctor's office without anesthesia, and the bands do not stay on permanently 1.

Key Points to Consider

• The band cuts off blood supply to the hemorrhoid tissue, causing it to shrink and fall off within about 1-2 weeks 1.
• The procedure typically takes just a few minutes and can be performed in a doctor's office without anesthesia, though some patients may feel brief discomfort or pressure during band placement 1.
• After banding, patients might experience mild pain, bleeding, or discomfort for a few days, which can be managed with over-the-counter pain relievers, sitz baths, and increased fiber and water intake 1.
• Multiple sessions spaced 2-4 weeks apart may be needed if there are several hemorrhoids requiring treatment 1.
• The procedure works by triggering controlled tissue death of the hemorrhoid while promoting scar tissue formation that helps prevent recurrence 1.

Potential Complications and Considerations

• The most common complication of rubber band ligation is pain, which is reported in 5%–60% of treated patients 1.
• Other complications, such as abscess, urinary retention, band slippage, prolapse and thrombosis of adjacent hemorrhoids, and minor bleeding from the ulcer, occur in 5% of patients 1.
• Severe bleeding occasionally requires intervention when the eschar from the band sloughs, usually 1–2 weeks after treatment 1.
• Necrotizing pelvic sepsis is a rare complication of rubber band ligation 1.

From the Research

Banding Procedure for Hemorrhoids

• The banding procedure for hemorrhoids, also known as rubber band ligation, is a common treatment for internal hemorrhoids 2, 3, 4.
• The procedure involves placing a rubber band around the base of the hemorrhoid to cut off its blood supply, causing it to fall off within a few days 2, 3.
• The banding procedure can be performed using an endoscope with forward-view or retroflexion, or without an endoscope using a suction elastic band ligator or a forceps ligator 2.
• Single or multiple ligations can be performed in a single session, and local anaesthetic can be used to reduce post-procedure pain 2, 5.

Duration of Bands

• The rubber bands used in the procedure typically fall off within 5-7 days, but can take up to 2 weeks to fall off in some cases 4.
• After the band falls off, the hemorrhoid typically falls off with it, and the area heals within a few weeks 4.

Complications and Risks

• Complications of the banding procedure can include mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers 2.
• More severe complications, such as massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention, pelvic sepsis, and death, are rare but can occur 2, 3.
• Patients taking anti-platelet and/or anti-coagulant medication have a higher risk of bleeding complications 2, 4.