Rubber band ligation of haemorrhoids - THDLAB - CO UK

  • Indications
  • Rubber Band Ligation of Haemorrhoids: the procedure
  • Outcomes and benefits


In the 1950s haermorrhoids banding was presented as a new technique for the ligation of bleeding internal haemorrhoids and was deemed to be suitable to be performed in the office with no need for hospitalisation.1

Today, rubber band ligation is generally indicated for the treatment of symptomatic internal haemorrhoids that do not respond to ‘home’ treatments. It is normally used for the management of grade I-II haemorrhoids 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 Haemorrhoids: the procedure

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

Traditional Rubber Band Ligation of Haemorrhoids

In the traditional system, the surgeon usually performs a rubber band ligation by means of a reusable metal anoscope, 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 haemorrhoid 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 haemorrhoidal tissue. As a consequence, the haemorrhoidal 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 haemorrhoid banding is traditionally performed and the features of the rubber band ligation kit commonly used could have several disadvantages:

  • reusable metal 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 sterilisations may cause the ligators welding points to fracture
  • an external light source is required
  • need for a grasper and for an assistant to hold the anoscope

The use of forceps often causes high intra-procedure bleeding and severe pain after treatment, requiring analgesics. Now there are new techniques and systems that 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 haemorrhoid rubber band ligation more comfortable and safer for both surgeon and patient, reducing operating times and costs as well as post-operative complications.

Find out 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 low-cost 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 to symptomatic haemorrhoids due to a reported recurrence rate ranging from 11% to over 50%.3 Consequently, for more severe grades of haemorrhoidal disease with prolapse, surgical treatments are usually recommended.

The most frequent complications of rubber banding procedure are bleeding and pain4 which 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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