Hemorrhoidal Artery Ligation vs Rubber Band Ligation for Hemorrhoid Management

Albert B. Lowenfels, MD


November 10, 2016

Haemorrhoidal Artery Ligation Versus Rubber Band Ligation for the Management of Symptomatic Second-Degree and Third-Degree Haemorrhoids (HubBLe): A Multicentre, Open-Label, Randomised Controlled Trial

Brown SR, Tiernan JP, Watson AJ, et al; HubBLe Study team
Lancet. 2016;388:356-364


How does hemorrhoidal artery ligation (HAL) compare with rubber band ligation (RBL) for managing symptomatic second- and third-degree hemorrhoids? Brown and colleagues performed a multicenter, randomized controlled trial comparing 185 patients undergoing HAL with 187 patients undergoing RBL. After 1 year, 49% of patients in the RBL group had hemorrhoid recurrence versus 30% in the HAL group. In the first week, pain scores were significantly lower in the RBL group (P=.001), but this difference disappeared after 3 weeks. At 21 days, patient-reported perceived health benefits were similar in the two groups. A cost-utility analysis revealed that the costs were significantly lower in the RBL group.


Although surgical excision has been a common treatment for hemorrhoids, this carefully performed study compared two newer treatment options: Doppler-guided HAL and RBL. Hemorrhoid recurrence rates were lower and initial pain was higher with HAL than with RBL. The mean total cost per patient was substantially less with RBL, and patient satisfaction with either procedure was about the same. These two alternative treatments to surgical excision have similar outcomes and patient satisfaction scores. RBL could be an attractive option if patients understand and accept the need for a repeat banding procedure.


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