Rubber band ligation of hemorrhoids

Rubber band ligation

  • Indications
  • Rubber Band Ligation of Hemorrhoids: procedure
  • Outcomes and benefits


In the 1950s rubber band ligation was presented as a new technique for the ligation of bleeding internal hemorrhoids which was suitable to be performed in a doctor's office with no need for hospitalization.1

Today, rubber band ligation is today generally indicated for the treatment of symptomatic internal hemorrhoids that do not respond to home treatments. It is normally used for the management of grade I-II hemorrhoids without prolapse.2


  1. Blaisdell PC. Office ligation of internal hemorrhoids. Am J Surg. 1958; 96: 401–404.
  2. The non-surgical management for hemorrhoidal disease. A systematic review, G. Cocorullo, et al Il Giornale di Chirurgia, 38(1): 5-14, January 2017.

Rubber Band Ligation of Hemorrhoids: Procedure

Rubber-band ligation, also called hemorrhoid banding, is one of the most common and cost-effective minimally invasive office procedures for the treatment of hemorrhoids.

Traditional Rubber Band Ligation

In the traditional system, the surgeon usually performs rubber band ligation by means of a reusable metal anoscope, a ligator and forceps. During the procedure, an external light source illuminates the area being treated, and a nurse usually holds the anoscope in place.

The surgeon inserts the anoscope into the anal opening, grasps the hemorrhoid with forceps and places it into the opening of the ligator. The ligator is then pushed against the base of the hemorrhoid cushion: here the surgeon applies a rubber band to reduce blood supply to the hemorrhoidal tissue. As a consequence, the hemorrhoidal mass shrinks and falls off within a few days.

When compared with other office procedures, rubber band ligation presents better results supported by clinical evidence1, 2, 3. However, the way hemorrhoid banding is traditionally performed and the features of the rubber band ligation kit commonly used shows several disadvantages:

  • metal reusable anoscopes often do not allow for a clear view of the surgical area and may be uncomfortable to use and disinfect
  • steel obturators may not slide into the anoscope smoothly
  • frequent sterilizations may cause ligators welding points to fracture
  • an external light source is needed
  • need for a grasper and for an assistant to hold the anoscope

Moreover, the use of forceps often causes high intra-procedure bleeding and severe pain after surgery, requiring analgesics. That’s why new techniques are available for rubber band ligation which have replaced forceps with suction units, which are easier to use and have fewer complications for patients.

THD® Bandy: a new approach to Rubber Band Ligation

THD® Bandy makes rubber band ligation easier to perform, thanks to a fully disposable kit, with innovative features that solve most of the disadvantages of the traditional procedure.

THD® Bandy makes hemorrhoid rubber band ligation more comfortable and safer for both surgeon and patient, reducing operating times and costs as well as post-operative complications.

Learn more about THD® Bandy and its benefits at THD® Bandy.


  1. Evaluation of Office Ligation In The Treatment of Hemorrhoids at Nepalgunj Medical College Teaching Hospital. Ansari, Mishara, KC. Journal of Nepalgunj Medical College, 2015.
  2. A prospective study of efficacy and safety of rubber band ligation in the treatment of Grade II and III hemorrhoids – a western Indian experience. Vinayak Nikam, Aparna Deshpande, Iti Chandorkar, Siddharth Sahoo. J Coloproctol (Rio J). 2018; 38(3): 189-193.
  3. Endoscopic hemorrhoidal ligation: preliminary clinical experience. Trowers EA, Ganga U, Rizk R, Ojo E, Hodges D. Gastrointest Endosc. 1998 Jul;48(1):49-52.

Outcomes and benefits

Rubber band ligation is a minimally invasive and cost-effective procedure. Compared to other outpatient procedures, rubber band ligation shows better long-term efficacy and normally requires fewer treatment sessions.1,2

However, it cannot usually be considered a permanent solution due to a reported recurrence rate ranging from 11% to over 50%.3 Consequently, for more severe grades of hemorrhoidal disease with prolapse, surgical treatments are usually recommended.

Bleeding and pain are the most frequent complications of rubber banding procedure4 and they usually resolve within a few days. Therefore, early recognition and prompt treatment of complications are very important to reduce patient discomfort.

In recent times, technological innovation and medical research have made it possible to develop devices that allow for a significant reduction of both intra-operative and post-operative complications.


  1. MacRae HM, McLeod RS. Comparison of hemorrhoidal treatment modalities. A meta-analysis. Dis Colon Rectum. 1995; 38: 687–694.
  2. Johanson JF, Rimm A. Optimal nonsurgical treatment of hemorrhoids: a comparative analysis of infrared coagulation, rubber band ligation, and injection sclerotherapy. Am J Gastroenterol. 1992; 87: 1600–1606.
  3. Haemorrhoids: an update on management, Therapeutic Advances in Chronic Disease, Steve R. Brown, 2017, Vol. 8(10) 141–147.
  4. The non-surgical management for hemorrhoidal disease. A systematic review, G. Cocorullo, et al Il Giornale di Chirurgia, 38(1): 5-14, January 2017.
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