Internal Hemorrhoid Band Ligation Periprocedural Care

Updated: Nov 05, 2020
  • Author: Assaad M Soweid, MD, FACG, FASGE; Chief Editor: Vikram Kate, MBBS, PhD, MS, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, FFST(Ed), MAMS, MASCRS  more...
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Periprocedural Care

Patient Education and Consent

Patients should be informed about the risks and benefits of hemorrhoid band ligation (HBL), including the risks of conscious sedation (eg, desaturation, cardiovascular events). Patients should be educated regarding the possibility of symptom recurrence. The patient’s informed consent should be obtained (including the possible need for blood transfusion). Elements of informed consent include the risks and benefits, alternatives, confidentiality, and expectations and length of the procedure.

Patients are kept on NPO (nil per os) status after midnight the day of the procedure, and bowel preparation instructions are given to the patient.



Equipment includes a gastroscope, flexible sigmoidoscope, colonoscope, or anoscope with forceps applicator, and the set of rubber bands (six- or 10-shooter variceal ligator). [5]


Patient Preparation

Patients should receive bowel cleansing preparations (as used before a regular colonoscopy). In the procedure room, the standard pre-endoscopy preparations (intravenous line, blood pressure, cardiac monitoring, oxygen supplementation) should be done as per guidelines from the American College of Gastroenterology (ACG) or the American Society for Gastrointestinal Endoscopy (ASGE).


HBL can be performed after premedication with midazolam, pethidine, or both. Sometimes, depending on the patient tolerability, propofol can be used. A randomized, controlled trial by Kwok et al found local anesthetic injection at the time of banding to be safe and effective. [24]  A study by Behrenbuch et al found that local anesthesia for HBL led to decreases in immediate postoperative recovery time and use of opioid analgesia. [25]


The patient should be positioned in the left lateral decubitus position for endoscopic HBL.


Monitoring & Follow-up

Patients undergoing HBL should be monitored for immediate postprocedural pain. Patients should also be instructed to watch for symptoms of fever, chills, hematochezia, purulent rectal discharge, and urinary retention for the first few days after HBL. Clinicians should be vigilant in following high-risk patients who still suffer from other conditions after the procedure. [26]

Follow-up for around 7-10 days after banding is requested to exclude the possibility of delayed hemorrhage.