Rubber Band Ligation | Hemorrhoid Rubber Band Ligation Treatments
Rubber Band Ligation
- Surgeons for years have been searching for a simple method of ligating hemorrhoids without the need for a general anesthetic or admission to hospital.
- Rubber band ligation is an ideal method for treating first degree and second degree internal piles in absence of tags or external hemorrhoidal component.
- Each hemorrhoid is visualized through the proctoscope. The upper part of mucocutaenous line is grasped by an instrument and a small elastic band is slipped over it.
- A recent development uses a modified proctoscope with bands stretched over the inner drum and pushed off by advancing the outer drum of the proctoscope over it.
- The tissue distal to the elastic band undergoes necrosis and excess mucosa in the anal canal is removed.
- The lower anal mucosa is drawn up by the ensuing fibrosis, which also causes adherence of the mucosa to the underlying muscle.
Advantages of Rubber Band Ligation
- The whole operation can be done without assistance.
- The band can be placed over larger piles.
- Band is inserted so that it occludes the base of the hemorrhoid at least 1cm above the dentate line.
- Should the dentate line be included in the ligating band considerable pain will result.
- Two bands are simultaneously inserted over each hemorrhoid as this reduces the risk of secondary hemorrhage.
- The ligated hemorrhoid will necrose in 24-48hrs and slough off in about 7days.
Disadvantage of Rubber Band Ligation
- It is associated with pain, which is more or less always experienced for the first 24-48hrs and sometimes pain is very severe.
- Secondary hemorrhage is another problem.
- One or two hemorrhoids can be banded at a time and three large hemorrhoids should not be banded at a time lest subsequent ulceration covers a large area resulting in stenosis.
- In absence of complications the patient is reviewed one month later and any further hemorrhoid is banded or injected as seems most appropriate.
