Patient indicates preference following surgery consultation. A band ligature is passed through an anoscope and placed on the rectal mucosa above the dentate line. Tissue eventually sloughs off in a week and leaves an ulcer that becomes fibrotic. Infrared coagulation serves best for Grade I, II, and some Grade III cases. It is as effective as banding and with fewer and less severe complications.
Light energy coagulates the hemorrhoid tissue.
Bipolar electrocoagulation, best for higher-grade hemorrhoids, quickly coagulates the hemorrhoid tissue, leaving a white scar. Low voltage direct current works best for higher grades. It requires grounding time and provides excellent control of pain. Sclerotherapy works if banding is not possible or if bleeding is a problem. Drawbacks include greater incidence of a poor outcome, possibility of anaphylaxis, sepsis, and ulceration.