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.