Rubber band ligation of haemorrhoids: indications
In the 1950s, rubber band ligation was introduced as a new technique for ligating bleeding internal haemorrhoids, suitable for ambulatory use without the need for hospitalisation1.
Haemorrhoids banding is today generally indicated for the symptomatic treatment of internal haemorrhoids which do not respond to conservative therapies. Rubber band ligation is often used for the management of grade I and II haemorrhoids without prolapse2.
- Blaisdell PC. Office ligation of internal hemorrhoids. Am J Surg. 1958; 96: 401–404.
- The non-surgical management for hemorrhoidal disease. A systematic review, G. Cocorullo, et al Il Giornale di Chirurgia, 38(1): 5-14, January 2017
Rubber band ligation of haemorrhoids: procedure
The rubber band ligation of haemorrhoids is one of the most common and economical procedures for minimally invasive day hospital treatment of haemorrhoids.
Conventional haemorrhoid ligation
In the traditional procedure, the surgeon usually performs the rubber band ligation with the aid of a reusable metal anoscope, a ligator and forceps. During the operation, an external light source illuminates the treated area, while the anoscope is kept in position by an assistant.
The surgeon introduces the anoscope into the anus, grabs the haemorrhoid cushion with the forceps and inserts it into the ligator opening. The ligator is then pushed towards the haemorrhoid cushion, at the base of which a rubber band is applied to reduce the flow of blood to the haemorrhoidal tissue. As a result, the haemorrhoid cushion shrinks and falls within a few days.
When compared with other day hospital procedures for treating haemorrhoids, rubber band ligation has better results supported by clinical evidence. However, the way in which the ligation of haemorrhoids is traditionally performed and the features of the commonly used instruments have several disadvantages:
- reusable metal obturators do not provide a clear view of the operating field and are inconvenient to use and disinfect.
- Metal obturators do not always slide easily into the anoscope.
- frequent sterilisation can cause the ligators’ welding points to break.
- an external light source is required.
- the use of forceps and the presence of an assistant is required to keep the anoscope in place.
Furthermore, the use of forceps often causes intra-operative bleeding and intense pain after surgery and frequently requires analgesics. For this reason, the latest generation of devices for rubber band ligation envisages replacing the forceps with suction units which are easier to use and have a low level of complications for the patient.
THD® Bandy: a new approach to the rubber band ligation of haemorrhoids
THD® Bandy makes the rubber band ligation of haemorrhoids easier to perform thanks to its innovative features that allow overcoming many of the limitations associated with traditional ligation.
THD® Bandy makes the execution of the rubber ligation more comfortable and safe for both the surgeon and the patient, allowing a reduction in time and operating costs and of post-surgery complications.
For further information on the features and advantages of THD® Bandy, click here.
Rubber band ligation of haemorrhoids: clinical efficacy and advantages
Rubber band ligation of haemorrhoids is a minimally invasive and convenient outpatient procedure.
Compared with other outpatient operations, rubber band ligation shows better long-term efficacy and normally requires fewer interventions. 1,2
However, this procedure cannot be considered a permanent solution due to the recurrence rate ranging between 11% and 50%, as documented in the literature.3 For this reason, in the most severe degrees of haemorrhoids and in the presence of prolapse, surgical treatment is usually recommended.
Pain and bleeding are the most frequent complications of the rubber band ligation procedure of haemorrhoids4 and are usually resolved within a few days. Early identification and the timely treatment of post-operative complications are important in order to reduce patient discomfort.
However, in recent years, technological innovation and medical research have allowed the development of devices (hyperlink to page THD Bandy https://thdlab.it/healthcare-professionals/products/thd-bandy) which significantly reduce operative and post-operative complications.
- MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum. 1995; 38: 687–694.
- Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J Gastroenterol. 1992; 87: 1600–1606.
- Haemorrhoids: an update on management, Therapeutic Advances in Chronic Disease, Steve R. Brown, 2017, Vol. 8(10) 141–147 4. The non-surgical management for hemorrhoidal disease. A systematic review, G. Cocorullo, et al Il Giornale di Chirurgia, 38(1): 5-14, January 2017