Rubber band ligation

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Rubber band ligation
Intervention
ICD-9-CM	49.45

Rubber band ligation is an outpatient treatment for second-degree internal hemorrhoids.

In this procedure, a small band is applied to the base of the hemorrhoid, stopping the blood supply to the hemorrhoidal mass. The hemorrhoid will then shrivel and die within 2 to 7 days. The shriveled hemorrhoid and band will fall off during normal bowel movements.

Rubber band ligation is a popular procedure, as it involves less pain than surgical treatments of hemorrhoids, as well as a shorter recovery period. Its success rate is between 60 and 80%.

History

Ligation of hemorrhoids was first recorded by Hippocrates in 460 BC, who wrote about using thread to tie off hemorrhoids.

In modern history, ligation using rubber band was introduced in 1958 by Blaisdell and refined in 1963 by Barron, who introduced a mechanical device called the Barron ligator.

In 1997, the CRH-O'Regan ligator was approved by the FDA to treat hemorrhoids. Dr. Patrick J. O’Regan invented the patented disposable device. Dr. O'Regan is Head of Minimally Invasive Surgery, King Faisal Specialist Hospital in Saudi Arabia and was previously at the University of British Columbia in Vancouver.

In 2006, Dr. Alan Goldman, a board certified surgeon, introduced the CRH-O'Regan System to the United States. At his hemorrhoid center in Atlanta, Georgia they have treated over 15,000 patients suffering from hemorrhoids or anal fissures. Avoiding surgery by using non-operative office treatments is a major advancement in medical care.

Procedure

Rubber band ligation procedure is as follows:

1. Pre-treatment diagnosis and prescribed medications
   • After diagnosis of the second-degree hemorrhoid, antibiotics are often prescribed, especially to patients with immune deficiency or other medical conditions. Sometimes, a couple weeks of Mesalamine is prescribed prior to the rubber band ligation procedure.
2. Positioning
   • The patient is laid down on the left side, with knees drawn up and buttocks projecting over the operating table.
3. Application of the band
   • A proctoscope is inserted into the anal opening. The hemorrhoid is grasped by forceps and maneuvered into the cylindrical opening of the ligator. The ligator is then pushed up against the base of the hemorrhoid, and the rubber band is applied.

• The CRH-O’Regan ligation system eliminates the use of forceps. The device applies gentle suction which allows the doctor to place a small rubber-band around the base of the hemorrhoid.

Complications

Possible complications from rubber band ligation include:

• Pain
• Bleeding
• Band slippage or breakage
• Infection and pelvic sepsis
• Thrombosed hemorrhoids
• Anal fissure

Post-procedure instructions for patients

• Patient may experience some bleeding, especially after bowel movements. This may last for several days or more. If the patient thinks it is severe or persistent, the patient should contact his/her doctor.
• Patient should not take aspirin or anything containing Ibuprofen for at least 14 days to minimize bleeding.
• Acetaminophen could be taken for any discomfort the patient may feel. A warm bath for about 10 minutes, 2-3 times a day, may help.
• No heavy lifting or strenuous activities for 3–4 days.
• A stool softener such as Surfak is recommended once a day for about 3 days. Stool softeners are available over the counter at any drug store.
• Patient should avoid straining to have a bowel movement. If patient does not succeed at first, he/she should try getting in a warm bath for about 10 minutes.

External links

• Yale New Haven Health
• WebMD Health Guide
• [1]