Complications of rubber band ligation of symptomatic internal hemorrhoids

Abstract

In a prospective study, 512 patients undergoing hemorrhoidal band ligation over a seven-year period were followed up to focus on complications. Thirteen patients (2.5 percent) were hospitalized: six with delayed massive rectal bleeding, three with urinary retention, pain, and fever (one developed perianal abscess), and three others with severe pain due to prolapsed thrombotic hemorrhoids (one developed difficulty in urination). One patient developed perianal abscess and perianal fistula two months after ligation. Twenty-four patients (4.6 percent) suffered from minor complications: 11 patients had painful thrombosed hemorrhoids; five experienced slippage of bands; three had mild bleeding; two developed band-related mucosal ulcer; one experienced each time, after two subsequent ligations, priapism lasting several hours; and difficulty in urination and tender induration above the dentate line occurred in two other patients. Rubber band ligation is, in effect, a miniature hemorrhoidectomy and has been considered, until recent reports of fatalities associated with this procedure, as an effective, safe, and efficient method of treating symptomatic second-degree and third-degree hemorrhoids. We conclude that the ability to handle complications that occur secondary to the rubber band ligation and, thereby, prevent sepsis and the low rate of major complications in our study justify reliance on this method of treating symptomatic hemorrhoids.

The HubBLe Trial: haemorrhoidal artery ligation (HAL) versus rubber band ligation (RBL) for symptomatic second- and third-degree haemorrhoids: a multicentre randomised controlled trial and health-economic evaluation

“…5 The incidence of bleeding after RBL is 1-2.8%. 3,77 Significant bleeding requiring admission or intervention is more difficult to analyse, but pooling of the data available suggests an incidence of 0.7%, 3,11,[14][15][16][17][18] Bleeding is more common if patients are taking anti-platelet agents, non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulants. 3 These patients were excluded in our trial.…”

“…Urinary retention has been described after both HAL and RBL, with a reported incidence of 0.7% after HAL 5 and about 0.3% after RBL. 3,11,14,15,17,18,83 Urinary retention is dependent on the severity of disease and degree of surgery, the analgesia requirement and pre-existing bladder outlet compromise. [85][86][87] In addition, day case treatment may reduce the incidence.…”

“…Pain is common for a few hours following RBL and occasionally patients experience pain so severe as to require admission to hospital (around 1% 3 ), bleeding (3-4%, sometimes necessitating further treatment 9 ) and vasovagal symptoms (3% 13 ). There have also been rare incidences of blood transfusion 3,11,[14][15][16][17][18] and severe pelvic sepsis, with a few instances leading to death. 13 Recurrences can be treated by re-banding or by surgical intervention.…”

A Prospective Audit of Early Pain and Patient Satisfaction Following Out-Patient Band Ligation of Haemorrhoids

“…The commonest complications of RBL are pain and rectal bleeding; however, the reported incidence of these varies considerably. [2][3][4] Vaso-vagal symptoms, urinary dysfunction, haemorrhoid thrombosis, mucosal ulceration and septic complications may also occur. We conducted a prospective audit of patient outcomes and satisfaction in the first week following RBL of symptomatic haemorrhoids.…”

Can 5-aminosalicylic acid suppository decrease the pain after rectal band ligation?

“…RBL, which is an easy and inexpensive procedure, is used to treat second-degree hemorrhoids, and surgery is often necessary for third and fourth degree hemorrhoids [3] . Although RBL is a well-established treatment of choice for symptomatic internal hemorrhoids, fatalities following RBL have been reported [4][5][6] . Following this treatment some patients experience pain which may be accompanied by itching.…”