What is Rubber Band Ligation & how is it done? – Dr. Nagaraj B. Puttaswamy

When we talk about hemorrhoids and piles, we have to differentiate the piles into 2 forms, internal and external and we are more worried about the internal hemorrhoids, they descend a little inside from the rectal region and we try to treat the internal hemorrhoids only when the grading is beyond 2. We grade the hemorrhoids as 1, 2, 3, 4 and beyond 2 only we try to treat and particularly when the patient has come with symptom of most commonly bleeding. There are multiple options of treating the hemorrhoidal problems. The commonest procedure what we do is the conventional hemorrhoidectomy, that is the removal of the hemorrhoids but unfortunately this is one of the most painful procedures what we can execute and if the patient has an inhibition to see the surgeon, so we try to resort into some alternative medications and treatment options that the patient will not feel incomplete. Smaller option will be the banding of the hemorrhoidal veins or cryolaser or cold laser technique and of late we are doing lot of surgical procedures like Doppler located arterial ligation of the hemorrhoids and the more advanced is the stapler hemorrhoidectomy. Al these procedures have their own advantages and disadvantages. But hemorrhoidal banding is one technique which is time tested and is relatively old also. It is a very simple technique and we use a small instrument called the rubber band applicator wherein the rubber band would have been preloaded and the applicator will go into the anal region and the rectal region and one hemorrhoidal vein picker will be there thought the applicator and the vein will be pulled in to the hemorrhoidal applicator and the band gets pushed with the instrument into the vein.SO this is the technique how the hemorrhoidal banding is done. So what happens after the application is done. This can be an outpatient procedure which can be done under local anesthesia and the patient goes immediately after the surgical procedure but some amount of discomfort and pain is expected to happen in the next few days. just because the rubber band is tightly placed around the anal veins and this is not in one place we do this, we try to do it in different places like the 5, 7 and the 11 o’clock position, as these are the places where we see the hemorrhoidal plexus in high concentration. Post this, the necrosed veins falls off, the rubber band also falls off in 7 – 8 days and some amount of bleeding is expected in that period. We expect them to be on laxatives and pain management and antibiotics to keep the management in order.