💅 Hemorrhoid Banding vs Hemorrhoidectomy Decision Simulator

Goligher Classification of Internal Hemorrhoids

Grade is the primary driver of treatment choice.

• No prolapse: Grade I (Bleeding only)
• Prolapse + reduces: Grade II (Spontaneous reduction)
• Prolapse, manual reduce: Grade III (Needs manual push)
• Irreducible: Grade IV (Permanently prolapsed)

Why grading matters

Placeholder: grade correlates with cushion size and fibrosis.

Grade I–II: The Banding Sweet Spot

Small reducible cushions ligate cleanly with low morbidity.

• ~80%: Success rate (Grade I–II)
• 1–3: Sessions needed (Spaced weeks apart)
• None: Anesthesia (Office procedure)
• <1 day: Downtime (Return to work fast)

Candidacy criteria

Placeholder: mobile tissue above the dentate line bands safely.

How the Rubber Band Strangles the Cushion

The band cuts blood supply, tissue necroses and sloughs off.

• Minutes: Ischemia onset (Band occludes flow)
• ~7 days: Sloughing (Tissue falls off)
• Weeks: Scar fixation (Anchors mucosa upward)
• ~2%: Complication rate (Bleeding, pain, thrombosis)

Mechanism summary

Placeholder: band placement above the dentate line avoids pain fibers.

Grade III–IV: When Surgery Is Warranted

Bulky, fibrotic, irreducible tissue outgrows banding's reach.

• High: Banding failure (Grade III–IV)
• ~95%: Hemorrhoidectomy cure (Durable resolution)
• 20–40 min: Operative time (Under anesthesia)
• Common: Combined disease (External component)

Surgical indication

Placeholder: excision removes redundant tissue that banding cannot reach.

Recovery, Pain, and Recurrence Trade-offs

Banding is quick and mild; surgery hurts more but lasts longer.

• 1–2 days: Banding recovery (Minimal pain)
• 2–4 weeks: Surgery recovery (Significant pain)
• 10–50%: Banding recurrence (Grade dependent)
• 2–5%: Surgery recurrence (Low, durable)

Choosing the right option

Placeholder: match invasiveness to grade to balance pain against recurrence.

Placeholder: grade-matched treatment minimizes unnecessary pain or failure.