The treatments for troublesome haemorrhoids that are bleeding or have only a minor prolapsing element and do not have a major external element may be conservative and or rubber band ligation or injection sclerotherapy.
Rubber band ligation has been shown to be superior to injection
sclerotherapy, with respect to effect on haemorrhoids in randomised
controlled trials. [SMM83,GSM85]
However, rubber banding is probably more painful that injection sclerotherapy.
Rubber banding was first described by Barron (Detroit) in 1963.
In banding the mucosa at least 1.5 cm above the dentate line is grasped with a forceps and the band is deployed.
Various types of applicators have been developed, including the one handed and two-handed systems. The advantage of the one handed system is that the surgeon may steady the proctoscope with the other hand. It may be possible to enlist the aid of the patient to hold the proctoscope if both hands are needed.
In some application systems (eg. Barron's bander) it is necessary to place a rubber `O-ring' on the apparatus, usually by pushing it on over a removable cone. A forceps is passed through the applicator to grasp the haemorrhoid. The applicator is pressed down over the forceps and the band deployed. The patient should not experience severe pain, if they do the band has been applied too low and should be released. There may be some discomfort after several hours due to venous congestion and infarction of the cushion distal to the band. This will slough in a few days and there may be some slight bleeding. A small ulcer remains, this will heal in 2 to 3 weeks.
About 70% of people who have rubber banding are free from
further signigicant trouble from their hemorrhoids at 5 years, by 10 years
the number `cured' has dropped to 50%.
[SRG+98]
