From the Guidelines
Rubber band ligation is a highly effective treatment for internal hemorrhoids, with a success rate of up to 80% and a low complication rate, as reported by Wrobleski et al. 1. The procedure involves the placement of a small rubber band around the base of the hemorrhoid, which cuts off the blood supply and causes the tissue to shrink and fall off within 1-2 weeks. Key points to consider when performing rubber band ligation include:
- The band must be placed at least 2 cm proximal to the dentate line to avoid severe pain due to somatic sensory nerve afferents 1.
- The procedure can be performed in an office setting without anesthesia, using specialized instruments such as suction devices or endoscopic variceal ligators 1.
- Up to 3 hemorrhoids can be banded in a single session, but many authorities prefer to limit treatment to 1 or 2 columns at a time 1.
- Potential complications include pain, abscess, urinary retention, and minor bleeding, but these are relatively rare and can be managed with sitz baths, over-the-counter analgesics, and other conservative measures 1.
- The recurrence rate may be as high as 68% at 4 or 5 years of follow-up, but symptoms usually respond to repeat ligation, and only 10% of patients require excisional hemorrhoidectomy 1. Overall, rubber band ligation is a safe and effective treatment for internal hemorrhoids, with a high success rate and low complication rate, making it a recommended treatment option for patients with first-, second-, or third-degree hemorrhoids 1.
From the Research
Overview of Rubber Band Ligation for Hemorrhoids
- Rubber band ligation is a commonly used treatment for internal hemorrhoids, particularly for grades 1,2, and 3 hemorrhoids 2, 3, 4.
- The procedure involves the use of an endoscope or a suction elastic band ligator to apply one or more rubber bands to the base of the hemorrhoid, cutting off its blood supply 2, 5.
Technique and Efficacy
- The technique can be employed with or without an endoscope, and single or multiple ligations can be performed in a single session 2.
- Rubber band ligation has been shown to be an effective treatment for hemorrhoids, with success rates ranging from 74% to 90% for grades 1,2, and 3 hemorrhoids 3, 5.
- The procedure is generally considered to be safe, with minor complications such as mild bleeding, pain, and vaso-vagal symptoms being the most common 2, 5.
Complications and Risks
- More severe complications, such as massive bleeding, thrombosed hemorrhoids, and pelvic sepsis, can occur but are rare 2, 6.
- Patients taking anti-platelet and/or anti-coagulant medication may have a higher risk of bleeding complications 2.
- Infectious complications, such as pelvic sepsis and Fournier's gangrene, have been reported but are extremely rare 2.