In the last few years there has been a considerable reduction in surgical treatment of piles; on the other hand a series of therapeutic outpatient treatments has developed aiming at a conservative management of piles. This new approach is mainly due to high costs in surgical treatment. In accordance also with the experience of the most important proctologic centres, nowadays only 26% of our patients suffering from piles undergo operation, since we regard rubber band ligation as a more rational and economical method for the treatment of hemorrhoids. The instruments and the technique related to band ligation have been described together with some modifications suggested by our personal experience. Indications and contraindications for rubber band ligation have been analyzed pointing out that, in our opinion, such an approach is advised also in the management of stage 3 and 4 hemorrhoids; on the other hand the surgical treatment has its role when band ligation is contraindicated. We have then reported about the good results obtained with 162 patients suffering from stage 2, 3 and 4 hemorrhoids, by using band ligation. Our experience, in accordance with international literature, enables us to emphasize the almost complete absence of complications and the satisfactory results of band ligation, even if compared to other methods.