• Rubber band ligation
• Suction bands are used.
• Up to 3 bands can be placed in a session for first or second degree haemorrhoids
• Most effective method of clinic treatment with 80% of patients satisfied with short term outcomes
• Bands should be applied above the dentate line to minimise pain
• Most common complications are pain and bleeding. Anticoagulated patients should not be banded. Localised infection or abscess can occur at the site of banding
• Ligation leads to thrombosis of the vein and causes local scarring to fix the mucosa on to the underlying muscle

Injection sclerotherapy
5% oily phenol is injected in the submucosa of the first or second degree haemorrhoid. It is less successful than banding.

Haemorrhoidectomy

• Up to three haemorrhoidal columns are dissected out from the underlying anal sphincter complex. The defect is closed with continuous absorbable suture in closed haemorrhoidectomy.
• Open haemorrhoidectomy is advocated by some surgeons to reduce the risk of infection. Here, the mucosal defect is left open and allowed to granulate by secondary intention.
• Complications include- secondary haemorrhage, infection, urinary retention, faecal incontinence due to sphincter damage and anal stenosis.

Stapled haemorrhoidopexy

• This is an alternative to surgical haemorrhoidectomy.
• A transanal circular stapling gun is used to excise a circumferential ring of mucosa and submucosa approximately 2-3 cm above the dentate line. It thus reduces the prolapsed mucosa and interrupts the haemorrhoidal blood supply.
• This technique can be offered to patients with second or third degree haemorrhoids that have not responded to outpatient treatment or even fourth degree haemorrhoids that are reducible under anaesthesia.
• It is a less painful alternative to surgical haemorrhoidectomy but recurrence rates are higher.
• Complications: bleeding, urinary retention, faecal incontinence, rectal perforation, rectovaginal fistulas, anastomotic leak, anal stricture, and infection