Skill Checkup: Rubber-Band Ligation of Hemorrhoids

Praveen K. Roy, MD


May 09, 2019

For most patients with hemorrhoids, outpatient treatment is feasible and sufficient. Rubber-band ligation is one of the most common outpatient treatments available. In this procedure, a rubber band is applied to the base of the hemorrhoid to hamper the blood supply to the hemorrhoidal mass. The hemorrhoid will then shrink and fall off within 2-7 days. It is readily performed in an ambulatory setting, and it causes less pain and has a shorter recovery period than surgical hemorrhoidectomy.

A more thorough review of rubber-band ligation of hemorrhoids is also available.


A Barron hemorrhoidal ligator with a hemorrhoid-grasping forceps is used. The ligator has a drum at one end over which rubber bands are loaded. It is connected with a 30-cm shaft to the handle, which has a trigger to release the bands. A loading cone is screwed over the drum of the Barron hemorrhoidal ligator. Two rubber rings/bands are slipped to load the ligator. The hemorrhoid-grasping forceps is then passed through the drum of the ligator and is now ready to grasp the hemorrhoid.

A proctoscope/anoscope is inserted into the anal opening. The hemorrhoids are visualized, and the most prominent hemorrhoid is addressed first. The assistant holds and maintains the position of the anoscope, while the operator holds the preloaded Barron band ligator with the grasping forceps. The internal hemorrhoid is grasped with the forceps about 1 cm proximal to the dentate line and is maneuvered into the drum of the ligator. If the patient complains of pain, a more proximal point should be selected for band ligation. The hemorrhoid is pulled taut through the drum of the ligator. The ligator is then pushed up against the base of the hemorrhoid, and the trigger is released to apply two rubber rings/bands to the base of the hemorrhoid. The process is repeated for other hemorrhoids.

Alternatively, a suction hemorrhoid ligator may be used. This instrument draws the hemorrhoidal mass into the drum through suction; therefore, the grasping forceps is not required. After the pile mass has been adequately drawn into the drum by means of suction, the trigger is released to apply the rings to the base of the hemorrhoid. Multiple pile masses may be ligated, but more than one banding session spaced over 3-4 weeks may be required. The procedure is shown in the video below.



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