He noted that the procedure produces fewer complications, and is less painful than hemorrhoidectomy. Dr. Salvati said that a number of patients are probably referred unnecessarily for surgery. Unless doctors perform the technique frequently, it is costly to invest in the ligation equipment, and easier to perform a hemorrhoidectomy. Ligation is effective for first, second, and third degree hemorrhoids, but not fourth, when the hemorrhoid comes out and cannot be pushed back in. In this case, a hemorrhoidectomy is required.
Ligation relies on the fact that there are no nerve endings to cut or burn up inside the rectum.
On the outside it's extremely sensitive. You would never see that patient again, except in a court of law. It's just too painful. Seven or eight deaths have been reported throughout the world, due to overwhelming sepsis following the ligation. He noted that trouble with voiding is a danger signal.