Rubber Band Ligation: A New Treatment Option for External Hemorrhoids

Hemorrhoids are dilated veins in the anal canal, classified into internal and external types based on their location relative to the dentate line. External hemorrhoids originate inferior to the dentate line from the inferior hemorrhoidal plexus. They are covered by the anoderm and are highly innervated by somatic pain receptors, leading to significant pain, especially when thrombosed. The management of external hemorrhoids has been primarily conservative, including increased fiber intake, stool softeners, and topical corticosteroids. More invasive treatments like hemorrhoidectomy or rubber band ligation have been avoided due to the intense postoperative pain and complications associated with such procedures. This case report and small patient cohort suggest rubber band ligation can be used as a minimally invasive procedure for the treatment of external hemorrhoids. A patient presenting with symptomatic non-thrombosed external hemorrhoids underwent rubber band ligation after being educated on the risks and benefits of the procedure. Lidocaine was injected into the surrounding tissue to anesthetize the hemorrhoid prior to band ligation. The rubber band was applied to the hemorrhoid, cutting off its blood supply and leading to ischemia, necrosis, and eventual sloughing of the tissue. Based on the success experienced by the first patient, a small patient cohort was offered the same treatment. In this cohort of 50 patients, 50% reported no post-procedure discomfort, 44% had mild pain managed with over-the-counter (OTC) analgesics, and three patients experienced moderate-severe pain that resolved within a week. Overall, ~90% were satisfied with the technique and would opt for the procedure again. This study demonstrates that rubber band ligation combined with local anesthesia injection could be an alternative option to hemorrhoidectomy for individuals with symptomatic non-thrombosed external hemorrhoids.