Is rubber band ligation (RBL) effective for hemorrhoids?

From the Guidelines

Banding for hemorrhoids is a highly effective treatment, with success rates ranging from 69% to 89% of patients being symptom-free at a mean follow-up of 5 years, as reported by Wrobleski et al. and Steinberg et al. 1.

Key Points to Consider

• The procedure is typically used for first-, second-, or third-degree hemorrhoids, and can be performed in an office setting without anesthesia.
• 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 usually be managed with sitz baths and over-the-counter analgesics.
• Other potential complications include abscess, urinary retention, band slippage, prolapse and thrombosis of adjacent hemorrhoids, and minor bleeding from the ulcer, which occur in 5% of patients.

Important Considerations for Treatment

• The encirclement of the hemorrhoid 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.
• The resulting scar from the procedure fixes the connective tissue to the rectal wall and resolves the prolapse.
• Follow-up with a doctor is important to monitor for potential complications and recurrence, which may be as high as 68% at 4 or 5 years of follow-up, but symptoms usually respond to repeat ligation.

From the Research

Banding for Hemorrhoids

• Banding, also known as rubber band ligation (RBL), is a common treatment for hemorrhoids, particularly for grade 1-3 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, 5.
• RBL has been shown to be effective in controlling symptoms such as bleeding, prolapse, and pain, with success rates ranging from 78% to 90% 2, 4.
• However, RBL can cause complications such as pain, bleeding, and discomfort, with post-procedural pain being a frequent complaint 5, 4.
• Compared to sclerotherapy, RBL has been shown to be more effective in controlling prolapse and bleeding, but may cause more post-procedural pain 4.

Comparison with Other Treatments

• RBL has been compared to other treatments such as sclerotherapy, infrared coagulation (IRC), and injection sclerotherapy (IS) in various studies 2, 3, 5, 4.
• A systematic review and meta-analysis found that RBL was more effective than sclerotherapy in controlling symptoms, but may cause more post-procedural pain 4.
• Another study found that IRC was associated with less pain and bleeding than RBL, but may not be as effective in controlling symptoms 5.

Patient Satisfaction and Recurrence

• Patient satisfaction with RBL has been reported to be high, with one study finding that 77.8% of patients were satisfied with the treatment 4.
• However, recurrence rates after RBL can be significant, ranging from 13% to 22% at 3-6 months follow-up 2, 5.
• Factors that may influence recurrence rates include the grade of the hemorrhoid, the number of bands used, and the presence of other underlying conditions 2, 4.