Should rubber band ligation of haemorrhoids be performed at the initial outpatient visit?

Despite careful technique, a proportion of patients undergoing rubber band ligation (RBL) of haemorrhoids will experience pain or discomfort. To investigate this, a group of 52 unselected patients presenting to the surgical outpatient clinic of Bristol Royal Infirmary were entered into a prospective study using questionnaires, of which 50 (96%) replied. Pain and discomfort were scored on a 10 cm visual analogue scale. Of these patients, 42 (84%) reported pain in the first 24 h; this was moderate to severe in 9 (18%); 30 (60%) had pain in the second 24 h, with 7 (14%) patients suffering moderate to severe pain. In all, 14 (28%) patients were unable to perform their normal activities on the day of treatment and a further 14 (28%) patients felt faint immediately after RBL. The results of this study indicate that pain after RBL occurs more often than previously recognised. It is suggested that informed consent be obtained before RBL and that patients should be given the opportunity to delay treatment if they so wish.