What is the role of rubber band ligation in the treatment of hemorrhoids?

Updated: Sep 24, 2019
  • Author: Kyle R Perry, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Rubber band ligation is the most-used remedy for grade II and grade III hemorrhoids and is the standard by which other methods are compared. This procedure is most common in the United States, because it is the most commonly taught method in training programs. [23] With experience, many third-degree and some fourth-degree internal hemorrhoids can be treated nonoperatively. Although rubber band ligation is effective in 75% of patients in the short term, it does not treat prolapsed hemorrhoids or those with a significant external component. [29]

Blaisdell [36] and Barron [37] described and refined ligation therapy. A band ligature is passed through an anoscope and placed on the rectal mucosa proximal to the dentate line. The tissue necroses and sloughs off in 1-2 weeks, leaving an ulcer that later fibroses. No anesthesia is required; complications are uncommon and usually benign.

When Jutabha et al compared endoscopic rubber band ligation with bipolar electrocoagulation for chronically bleeding grade II or III internal hemorrhoids that were unresponsive to medical therapy, ligation controlled rectal bleeding and other symptoms with significantly fewer treatments (2.3 ± 0.2) and had a significantly higher success rate (92%) than electrocoagulation (3.8 ± 0.4 and 62%, respectively). [38] However, severe pain during treatment occurred more often with ligation (8%) than with electrocoagulation (0%), albeit treatment failure and crossovers were significantly less frequent (8% vs 38%).

Necrotizing pelvic sepsis is a rare, but serious, complication of rubber band ligation. The diagnosis is suggested by the triad of severe pain, fever, and urinary retention. It occurs 1-2 weeks after ligation, frequently in immune-compromised patients, and requires prompt surgical debridement.

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