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Complications of rubber band ligation of symptomatic internal hemorrhoids


In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.

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  1. 1.

    Welling DR, Wolff BG, Dozois RR. Piles of defeat: Napoleon at Waterloo. Dis Colon Rectum 1988; 31:303–5.

    PubMed  CAS  Google Scholar 

  2. 2.

    Haas PA, Fox TA Jr, Haas GP. The pathogenesis of hemorrhoids. Dis Colon Rectum 1984;27:442–50.

    PubMed  CAS  Google Scholar 

  3. 3.

    Marino AW Jr, Mazier WP, Morgan B, Salvati EP, Smith LE. Anorectal surgery—hemorroids. Dis Colon Rectum 1980;23:211–22.

    Google Scholar 

  4. 4.

    Johanson JE, Sonnenberg A. The prevalence of hemorrhoids and chronic constipation. Gastroenterology 1990;98:380–6.

    PubMed  CAS  Google Scholar 

  5. 5.

    Gehamy RA, Weakley FL. Internal hemorrhoidectomy by elastic ligation. Dis Colon Rectum 1974; 17:347–53.

    PubMed  CAS  Google Scholar 

  6. 6.

    Arabi Y, Gate House D, Alexander-Williams J, Keighley MR. Rubber band ligation or rectal subcutaneous sphincterotomy for treatment of hemorrhoids. Br J Surg 1977;64:739–40.

    Google Scholar 

  7. 7.

    Muller CA. Internal hemorrhoidectomy by rubber band ligation. Proctology 1980;5:317–9.

    Google Scholar 

  8. 8.

    Wrobleski DE, Corman ML, Veidenheimer MC, Coller JA. Long-term evaluation of rubber ring ligation in hemorrhoidal disease. Dis Colon Rectum 1980;23:478–82.

    Article  PubMed  CAS  Google Scholar 

  9. 9.

    Keighley MR. Randomized trial to compare photocoagulation with rubber band ligation for treatment of hemorrhoids. Proctology 1982;4:132–4.

    Google Scholar 

  10. 10.

    Walker AJ, Leicester RJ, Nicholls RJ, Mann CV. A prospective study of infrared coagulation, injection and rubber band ligation in the treatment of hemorrhoids. Int J Colorectal Dis 1990;5:113–6.

    PubMed  CAS  Google Scholar 

  11. 11.

    Jensen SL, Harling H, Arseth-Hansen P, Tange G. The natural history of symptomatic hemorrhoids. Int J Colorectal Dis 1989;4:41–4.

    PubMed  CAS  Google Scholar 

  12. 12.

    O'Hara VS. Fatal clostridial infection following hemorrhoid banding. Dis Colon Rectum 1980;23: 570–1.

    PubMed  Google Scholar 

  13. 13.

    Russell TR, Donohue JH. Hemorrhoidal banding: a warning. Dis Colon Rectum 1985;28:291–3.

    PubMed  CAS  Google Scholar 

  14. 14.

    Marshman D, Huber PJ Jr, Timmerman W, Simonton CT, Odom FC, Kaplan ER. Hemorrhoidal ligation: a review of efficacy. Dis Colon Rectum 1989;32: 369–77.

    PubMed  CAS  Google Scholar 

  15. 15.

    Mattana C, Maria G, Pescatori M. Rubber band ligation of hemorrhoids and rectal mucosal prolapse in constipated patients. Dis Colon Rectum 1989;32: 372–5.

    PubMed  CAS  Google Scholar 

  16. 16.

    Clay LD III, White JJ Jr, Davidson JT, Chandler JJ. Early recognition and successful management of pelvic cellulitis following hemorrhoidal banding. Dis Colon Rectum 1986;29:579–81.

    PubMed  Google Scholar 

  17. 17.

    Shemesh EI, Kodner IJ, Fry RD, Neufeld DM. Severe complication of rubber band ligation of internal hemorrhoids. Dis Colon Rectum 1987;30:199–200.

    PubMed  CAS  Google Scholar 

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Correspondence to E. Melzer M.D..

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Bat, L., Melzer, E., Koler, M. et al. Complications of rubber band ligation of symptomatic internal hemorrhoids. Dis Colon Rectum 36, 287–290 (1993).

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Key words

  • Hemorrhoids
  • Rubber band ligation
  • Complications