Rubber Band Ligation (Hemorrhoidal Artery Ligation)

Rubber band ligation, often known as haemorrhoid banding, is an effective medical treatment procedure with minimal invasiveness that treats haemorrhoids and helps prevent them from coming back. This procedure is most suited in those cases where home treatments do not respond well. The technique, however, may not be ideal for everyone. It is a procedure where the haemorrhoid is tied at its base with the rubber bands to cut off the blood supply to the haemorrhoid. In this method, the haemorrhoid falls off within 3-10 days along with a bit of blood. Some people return to their regular life straight after the procedure and some may require a bed rest of three days.

 

Rubber band ligation, often known as haemorrhoid banding, is an effective medical treatment procedure with minimal invasiveness that treats haemorrhoids and helps prevent them from coming back. This procedure is most suited in those cases where home treatments do not respond well. The technique, however, may not be ideal for everyone. It is a procedure where the haemorrhoid is tied at its base with the rubber bands to cut off the blood supply to the haemorrhoid. In this method, the haemorrhoid falls off within 3-10 days along with a bit of blood. Some people return to their regular life straight after the procedure and some may require a bed rest of three days.

 

The advantages of the rubber band ligation are indisputable:

1.  It offers the possibility of a definitive, ambulatorial with the least risk solution for Haemorrhoid treatment
2. No need of  necessity of hospitalisation and anaesthesia in  this procedure,
3.  the overall percentage of complications (0.4%) inferior to that of the surgical hemorrhoidectomy.

Rubber band ligation treatment is frequently used for internal haemorrhoids. Haemorrhoids arise due to increased pressure in the lower rectum, which is caused by a variety of factors:

1. Pelvic pressure from weight gain due to obesity or pregnancy.
2. Pushing hard for having a bowel movement (poop) because of constipation.
3. Sitting for long periods on the toilet.
4. Lifting heavy objects or weightlifting regularly.
5. Eating a low-fibre diet.

Haemorrhoids symptoms include:

1. Rectal bleeding
2. Severe aches or pain around the anus, especially when sitting.
3. Uncomfortable lump(s) or protrude and extreme itching through the anus (prolapsed haemorrhoid)
4. A blood clot (thrombosed haemorrhoid)

What will happen if surgery is delayed?

Complications arising from haemorrhoids are uncommon, but they include :

1. Anaemia – caused due to considerable blood loss from chronic haemorrhoids.
2. Strangulated haemorrhoid – caused due to severing of blood supply to the internal haemorrhoid, triggering extreme pain and posing a risk of infection.
3. Thrombosed haemorrhoid – caused due to formation of a blood clot, while not harmful, however, can be quite painful and requires occasional lancing and drainage.

Procedure Description

Rubber band ligation is the most common nonsurgical treatment for internal haemorrhoids, and it involves tying a tight band around the base to cut off the blood supply. This therapy is used by 80% of patients who are treated for haemorrhoids. To do this procedure:

1. A doctor inserts a viewing instrument called an anoscope into the anus by a doctor.
2. The haemorrhoid is held with grasping forceps
3. A Barron band ligator device then places a rubber band around the base of the haemorrhoid.
4. This technique cut off the blood flow to the haemorrhoid, thus shrinking,  and withering the haemorrhoids.
5.   The haemorrhoid falls off within 3-10 days. The patient does not feel anything but may experience a little bleeding.

There are various minor or major complications associated with this technique, such as :

1. Bleeding – caused by the sloughing of the ligated haemorrhoids after 10-14 days.
2. Pain – the most common complication of RBL.
3. Infectious complications –  Following RBL, several septic illnesses have been documented, including pelvic sepsis, tetanus, and so on. There have also been reports of deaths as a result of these infectious complications.

What to expect before surgery?

1. It is critical to understand the patient's medical history, including comorbidities and medications, before putting the bands.
2. A person should inform their doctor about all over-the-counter and prescription medications that they are taking, including OTC drugs and supplements. 
3. A doctor should also counsel the patient on which drugs to discontinue before the treatment and propose alternatives.
4. An enema can be given to the patient on the previous night of the procedure.
5. A doctor may also urge the patient to fast for several hours before having anaesthesia.

It's always suitable for the patient to have someone to accompany them to the procedure.

What to expect on the day of surgery?

The patient can be asked to sign an informed consent form consisting of the risk, benefits, alternatives, expectations, and procedure length.

Usually, local or topical anaesthesia administers to the rectum. 

However, in case of several haemorrhoids or severe pain, general anaesthesia might be required.

Anaesthesia may not be needed while performing this procedure in an office setting.

What to expect during surgery?

1. Rubber band ligation can be successfully performed in a hospital or an office environment. 
2. The physician uses an endoscope to hold the haemorrhoidal tissue with grasping forceps.
3. Then the physician inserts a small tool called a ligator in the anal canal and pushes it to place elastic bands 5 mm above the line that separates the dentate line (anal canal) around the base of the haemorrhoid to prevent clots.
4. This technique constricts the blood supply to haemorrhoids, thus shrinking, killing, and falling off it in about a week.
5. The entire rubber band ligation procedure takes about five minutes to complete; however, the exact time depends on the number of haemorrhoids present.
6. During the ligation process, the patient may experience some discomfort or uneasiness.

 

What to expect after surgery?

1. There are variations reported in people's response to this procedure, as some can return to regular activities almost immediately while others may require 2 to 3 days of bed rest.
2. Pain is likely to persist for 24-48 hours after the procedure; however, taking Tylenol (acetaminophen) helps in easing the pain.
3. Bleeding may persist for 7 to 10 days after the surgery.
4. Rest for 24-48 hours following the treatment and avoid heavy lifting and hard labour.
5. When defecating, avoid straining since it might induce additional haemorrhoids.
6. Stay hydrated, eat a healthy diet, and consume foods high in fibre.

 

Check out for the following symptoms and signs:

 

1. Fever \ Chills
2. Stools with blood
3. Pus discharge from the rectum and inability to pass urine
4. Persistent discomfort and pain
5. Dizziness and fainting 
6. Clots in the blood