Barron was the first to describe hemorrhoidal banding with rubber bands in 1963.Since this original description, there have been a number of reports that have documented the efficacy banding offers for the management of the majority of patients with bleeding stage II and III internal hemorrhoids.The procedure is generally well tolerated without the need for prescription analgesia if the band is placed above the level of the dentate line. The technique is demonstrated in the picture below . It is important to ask the patient if he or she experiences any pain during placement of the bander, before deployment of the band. Discomfort immediately after band placement may be reduced by the injection of a local anesthetic agent, but this does not appear to be a long-lasting benefit. Banding is associated with the rare but frequently fatal complication of postbanding sepsis, which is heralded by the symptoms of increasing rectal pain, fever, and inability to void.It is essential to treat these symptoms early and aggressively with early antibiotic treatment coupled with surgical drainage
Bayer et al. reported a series of 2934 patients in whom 79% of patients achieved complete relief of symptoms after a single session of banding at only one or two locations. With this approach, patients required multiple sessions for control of symptoms (two sessions, 32%; three sessions, 17%; four sessions, 25%; and five or more sessions, 20%). Only 2% of patients required hemorrhoidectomy. It may be possible to achieve a similar outcome with a shorter duration of therapy, albeit at the expense of greater post-treatment pain, by banding all symptomatic hemorrhoidal sites at the initial visit.Banding techniques appear to be durable after initial control of symptoms, with 69% of patients maintaining long-term relief and only 8% ultimately requiring excisional hemorrhoidectomy.
