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World J Gastrointest Surg. Sep 27, 2016; 8(9): 614-620
Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.614
Rubber band ligation of hemorrhoids: A guide for complications
Andreia Albuquerque
Andreia Albuquerque, Department of Gastroenterology, Centro Hospitalar São João, 4200-319 Porto, Portugal
Author contributions: Albuquerque A solely contributed to this manuscript.
Conflict-of-interest statement: There is no financial support or relationships that may pose conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Andreia Albuquerque, MD, Department of Gastroenterology, Centro Hospitalar São João, Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal. a.albuquerque.dias@gmail.com
Telephone: +351-225-512100 Fax: +351-225-025766
Received: April 13, 2016
Peer-review started: April 18, 2016
First decision: May 19, 2016
Revised: June 25, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: September 27, 2016
Processing time: 165 Days and 14.5 Hours
Abstract

Rubber band ligation is one of the most important, cost-effective and commonly used treatments for internal hemorrhoids. Different technical approaches were developed mainly to improve efficacy and safety. The technique can be employed using an endoscope with forward-view or retroflexion or without an endoscope, using a suction elastic band ligator or a forceps ligator. Single or multiple ligations can be performed in a single session. Local anaesthetic after ligation can also be used to reduce the post-procedure pain. Mild bleeding, pain, vaso-vagal symptoms, slippage of bands, priapism, difficulty in urination, anal fissure, and chronic longitudinal ulcers are normally considered minor complications, more frequently encountered. Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis and death are uncommon major complications. Mild pain after rubber band ligation is the most common complication with a high frequency in some studies. Secondary bleeding normally occurs 10 to 14 d after banding and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening haemorrhage. Several infectious complications have also been reported including pelvic sepsis, Fournier’s gangrene, liver abscesses, tetanus and bacterial endocarditis. To date, seven deaths due to these infectious complications were described. Early recognition and immediate treatment of complications are fundamental for a favourable prognosis.

Keywords: Hemorrhoids; Rubber band ligation; Pain; Bleeding; Infection

Core tip: Rubber band ligation of hemorrhoids is a very effective non-surgical treatment for internal hemorrhoids. Different techniques were developed mainly to improve efficacy and safety. This is an overall safe procedure, although severe complications can occur, such as infections. It is very important to know these possible complications to reduce their risk and to allow early recognition and successful treatment.