ROSH Gastrointestinal Practice Exam

For a patient with non-strangulated internal hemorrhoids not improving with topical treatment, what is the most recommended next step?

1. Injection sclerotherapy

2. Lord's procedure

3. Operative hemorrhoidectomy

4. Rubber band ligation

The correct answer is: Rubber band ligation

In cases of non-strangulated internal hemorrhoids that have not improved with topical treatments, the most recommended next step is rubber band ligation. This minimally invasive procedure involves placing a small rubber band around the base of the hemorrhoid, which cuts off its blood supply. As a result, the hemorrhoid tissue shrinks and eventually falls off. Rubber band ligation is a widely accepted treatment option for patients with symptomatic internal hemorrhoids, particularly when conservative measures fail. The advantage of rubber band ligation lies in its effectiveness and relatively low complication rate compared to more invasive surgical options. It can be performed in an outpatient setting, offers quick recovery time, and patients often experience significant relief from symptoms. In contrast, injection sclerotherapy is typically employed for smaller hemorrhoids or when ligation is not feasible, while Lord's procedure and operative hemorrhoidectomy are more invasive treatments indicated for severe cases or larger hemorrhoids and often involve longer recovery times.