Rubber band ligation of hemorrhoids: A guide for complications

Abstract

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.

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

“…These results were confirmed by Atallah et al [157] who reveal that THD can be performed on anticoagulated patients without cessation of oral agents without an increased risk of postoperative bleeding. Nevertheless, Albuquerque [158] suggested that secondary bleeding normally occurs 10-14 days after RBL and patients taking anti-platelet and/or anti-coagulant medication have a higher risk, with some reports of massive life-threatening hemorrhage (Level of evidence: 2; Grade of recommendation: C).…”

“…Several studies described different complication rates following office procedures (such as RBL, sclerotherapy, and infrared coagulation), ranging from 3% to 18.8% [158,178]. A review of 39 studies including 8060 patients who had RBL revealed post-banding complications in 14% of the patients, although severe complications are rarely reported [179].…”

“…Several infectious complications have also been reported following office procedures (such as RBL, sclerotherapy, and cryotherapy) including pelvic sepsis, Fournier's gangrene, liver abscesses, tetanus, and bacterial endocarditis. Deaths due to these infectious complications have been reported too [158].…”

Treatment of patients with combined haemorrhoids by minimally invasive methods in outpatient conditions

“…Применение этого метода целесообразно на II и III стадиях геморроя, когда отсутствует выраженная дистрофия фиброзно-мышечного каркаса дистального отдела прямой кишки. Данный метод имеет невысокий процент осложнений, среди которых наиболее частыми (до 5 %) являются острые послеоперационные тромбозы наружных геморроидальных узлов [3,4]. При лечении пациентов этим методом возврат симптомов геморроя через 12 месяцев наблюдается у 10-25 % пациентов [5][6][7].…”

“…При сравнении наших результатов с литературными данными количество осложнений после латексного лигирования и отдаленные результаты согласуются с ними [4,7]. Так, по данным V. S. Lyer с соавторами [7], при проведении латексного лигирования острые тромбозы наружных геморроидальных узлов и другие осложнения наблюдаются с частотой до 5 % случаев.…”