Haemorrhoids: Rubber Band Ligation
Facts:
•Surgery for haemorrhoids should only be recommended to90% of such patients, therefore, are suitable for conservative measures and for interventional non-surgical office procedures, such as RBL
Pros of RBL
•Effective for bleeding internal haemorrhoids, up to 3rd degree, including small prolapse [Rivadeneira DE et al, Standards Practice Task Force of The American Society of Colon & Rectal Surgeons. Practice parameters for the management of hemorrhoids (revised 2010). Dis Colon Rectum 2011; 54: 1059-64].
•Cumulative Success Rate >80% (Iyer VS, Shrier I, Gordon PH. Long-Term outcome of rubber band ligation for symptomatic primary and recurrent internal hemorrhoids. Dis Colon Rectum 2004; 47: 1364-70).
- Safe
- Inexpensive
- Easy to organise / simple •Outpatient / office procedure
- Immediate recovery
- Performed (through an anoscope) employing either a Vacuum Suction or a Traditional Forcep Ligator
- Two bands (rings) are used on each drum and applied >1 cm above dentate line
Cons of RBL
- Rare complications (bleeding, sepsis, thrombosed haemorrhoids, pain, urinary retention, etc.)
- Recurrence ~20%
- Operator dependent
- Only one or two pair(s) of bands (rings) can be applied at one session
- Sessions can be repeated only after 20-30 days
- Full treatment may, therefore, require up to 3 or 4 months
- Contraindicated in patients on anticoagulants
- Contraindicated to treat external (skin covered) haemorrhoids
What to do, what to expect?
Procedure
- Thorough pre-procedure diagnosis to rule out coexisting causes of PR bleeding
- Outpatient / office procedure
- No enema / bowel prep required (usually)
- No fasting needed
- No sedation indicated
- Patient positioned in left lateral or Sims’ position
- Average procedure time: ~5 minutes (or less)
Post-procedure
- Work can typically be resumed same day or next day
- Recommended medications: stool softeners, antibiotic (prophylaxis), and pain relief (rarely needed
- Usually, only one or two 11 mm pair(s) of bands (rings) can be applied at one session
- Sense of “foreign body” and urge to move bowel for 24-48 hrs (tenesmus)
- After a few days (typical range: 5 to 10 days) the necrotized haemorrhoidal tissue and the bands (rings) slough away, with minimal bleeding
Background:
•Developed by James Barron (Detroit, Michigan, USA) in 1963 (based on Paul C Blaisdell idea, presented at the Scientific Exhibit of the American Medical Association of 1954).
1. Barron J. “Office ligation treatment of hemorrhoids”. Dis Colon Rectum 1963; 6: 109-13. 2. Barron J. ”Office ligation of internal hemorrhoids”. Am J Surg 1963; 105: 563-70. Facts:
•Surgery for haemorrhoids should only be recommended to90% of such patients, therefore, are suitable for conservative measures and for interventional non-surgical office procedures, such as RBL