A systematic review of over 700 studies suggested that surgery was better than rubber band ligation for the treatment of severe hemorrhoids.

The overall analysis indicated that hemorrhoid symptoms were 68 percent more likely to resolve with surgery than with RBL.

Further analysis showed that surgery was indeed better than RBL at resolving severe hemorrhoids, the type that protrude out of the anus when defecating and need to be pushed back inside manually. By contrast, the two forms of therapy were comparable at resolving less severe hemorrhoids, although patients treated with surgery were less likely to require repeat treatments in the future.

("Surgery favored for severe hemorrhoids", Reuters, Jul.21)