Rubber-Band Ligation of Hemorrhoids Periprocedural Care

Updated: Sep 05, 2017
  • Author: Pradeep Saxena, MBBS, MS; Chief Editor: Kurt E Roberts, MD  more...
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Periprocedural Care

Patient Education and Consent

Formal consent should always be obtained before placement of rubber bands to treat hemorrhoids because complications have been reported in randomized controlled trials. [6]

Patients should be advised that there is a recurrence rate of about 20-25% in 5 years.

Stool softeners and bulk agents should be prescribed, and the patient should avoid straining for bowel movements. The patient should be warned about the possibility of bleeding after the procedure and after 1-2 weeks when the rubber rings are dislodged. If the patient thinks that bleeding is severe or persistent, he or she should contact the surgeon.

In cases of pain or fever, the patient should come back for consultation. A sitz bath may be advised to keep the anal area clean and hygienic to prevent infections and reduce pain. The patient should be advised to avoid heavy lifting or strenuous activities for 3-4 days.

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Equipment

Equipment for hemorrhoid ligation includes the following:

  • Barron hemorrhoidal ligator with rubber rings/bands (see the image below)
  • Hemorrhoid-grasping forceps
  • Proctoscope/anoscope
  • Light source (torch)
  • Gauge piece
  • Artery forceps
Barron hemorrhoidal ligator with loading cone and Barron hemorrhoidal ligator with loading cone and grasping forceps.
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Patient Preparation

A proctoclysis enema is given just before the procedure. For lubrication and local anesthesia, 5% lidocaine jelly is applied locally in the anal canal. Infiltration of local anesthetic has also been employed. [12]

The patient should be in the left lateral position with the buttocks projecting well over the operating table.

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Monitoring & Follow-up

A single treatment can achieve satisfactory results. If the symptoms of bleeding and prolapse due to hemorrhoids are not relieved, further rubber-band ligation or other conservative treatment may be tried. If the symptoms are not controlled after three sessions, hemorrhoidectomy may be considered.

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