Skill Checkup: Rubber-Band Ligation of Hemorrhoids

Praveen K. Roy, MD


May 09, 2019

Rubber-band ligation is contraindicated for the following:

  • Patients using anticoagulants

  • Patients with a septic process in the anorectal region (eg, perianal abscess, proctitis, or colitis)

  • Patients with acutely thrombosed hemorrhoids

  • Patients with large grade IV hemorrhoids

  • Patients with hypertrophied anal papilla

  • Patients with chronic anal fissure (surgical treatment is more appropriate in such cases)

  • Cases in which insufficient tissue is available to be pulled inside the band ligator drum

Hemorrhoid ligation is performed for first-degree, second-degree, and some cases of third-degree hemorrhoids when the patient complains of bleeding or prolapse of hemorrhoids. Band ligation may also be considered for bleeding in severely anemic patients with fourth-degree hemorrhoids who are unfit for surgery.

Most complications of the procedure are minor and self-limiting; they can be managed on an outpatient basis. Complications of rubber-band hemorrhoid ligation include the following:

  • Pain (32%)

  • Vasovagal symptoms (dizziness and fainting)

  • Bleeding (1%-5%)

  • External hemorrhoid thrombosis (2%-3%)

  • Ulceration

  • Fulminant sepsis

Usually, one or two hemorrhoids are ligated at a time. Any remaining hemorrhoids may be ligated after a period of 4-6 weeks.

Read more information about rubber-band ligation of hemorrhoids.

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