Published online Sep 27, 2016. doi: 10.4240/wjgs.v8.i9.614
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
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.
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.