From the Guidelines
Rubber band ligation is a highly effective treatment for first-, second-, or third-degree hemorrhoids, with success rates ranging from 69% to 89% at a mean follow-up of 5 years, as reported by Wrobleski et al. and Steinberg et al. 1. The procedure involves the placement of small rubber bands around the base of hemorrhoids to cut off their blood supply, causing them to shrink and fall off within a week. It's typically recommended for grade 1-3 hemorrhoids that haven't responded to conservative treatments like dietary changes and topical medications. During the procedure, a doctor uses a specialized tool to place the bands around the hemorrhoid tissue above the dentate line, where there are fewer pain receptors, to minimize discomfort. Some key points to consider when performing rubber band ligation include:
- The encirclement must be well proximal (at least 2 cm) to the dentate line to avoid severe pain due to the presence of somatic sensory nerve afferents.
- Up to 3 hemorrhoids can be banded in a single session, although many authorities prefer to limit treatment to 1 or 2 columns at a time.
- The most common complication of rubber band ligation is pain, which is reported in 5%–60% of treated patients, but can be managed with sitz baths and over-the-counter analgesics.
- 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, and severe bleeding occasionally requires intervention when the eschar from the band sloughs, usually 1–2 weeks after treatment. The procedure works by causing the hemorrhoid tissue to necrose and slough off while scar tissue forms at the base, preventing recurrence by securing the remaining tissue in place, as described in the american gastroenterological association technical review on the diagnosis and treatment of hemorrhoids 1.
From the Research
Overview of Rubber Band Ligation
- Rubber band ligation is a treatment for hemorrhoids, particularly effective for grade II and III hemorrhoids without rectal mucosal prolapse 2.
- The procedure involves ligating each hemorrhoid with one rubber band through a ligator, and it has been shown to be efficacious, cost-effective, and simple 2.
Efficacy and Complications
- Studies have reported high success rates for rubber band ligation, with symptoms improving in a significant percentage of patients 2, 3, 4.
- However, complications such as rectal bleeding, anal pain, and feeling of a foreign body inside the anal canal can occur, although these are often self-limited and minor 2, 5, 4.
- Comparison with other treatments like infrared coagulation and sclerotherapy has shown that rubber band ligation can be effective, but may have a higher incidence of certain complications like delayed bleeding 6, 5.
Comparison with Other Treatments
- Infrared coagulation has been shown to be a simple, fast, and effective outpatient method for treating first and second degree hemorrhoids, with fewer troublesome side effects than rubber band ligation 5.
- BANANA-Clip has been compared to rubber band ligation in a study, showing that it may have higher success rates and fewer post-ligation complications, especially delayed bleeding 6.
- Sclerotherapy has been reported to have good results for grade II and III hemorrhoids, although it may have a higher recurrence rate compared to rubber band ligation 3, 4.
Patient Outcomes and Recurrence
- Patient outcomes after rubber band ligation have been reported to be generally good, with a significant percentage of patients experiencing improvement or resolution of symptoms 2, 3, 4.
- Recurrence rates have been reported to vary, but are generally lower for rubber band ligation compared to other non-surgical treatments like sclerotherapy 4.