Rubber band ligation

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Rubber band ligation
ICD-9-CM 49.45

Rubber band ligation (RBL) [1] is an outpatient treatment procedure for internal hemorrhoids of any grade. [2] There are several different devices a physician may use to perform the procedure, including the traditional metal devices, endoscopic banding, and the CRH O'Regan System.

Contents

With rubber band ligation, a small band is applied to the base of the hemorrhoid, stopping the blood supply to the hemorrhoidal mass. The hemorrhoid will shrink and fibrose within a few days with shriveled hemorrhoidal tissue and band falling off during normal bowel movements - likely without the patient noticing. [3]

Rubber band ligation is a popular procedure for the treatment of hemorrhoids, as it involves a much lower risk of pain than surgical treatments of hemorrhoids, as well as a shorter recovery period (if any at all). It is a very effective procedure and there are multiple methods available. When done with the CRH O’Regan System, it is also associated with a recurrence rate of 5% at 2 years. [4] The procedure is typically performed by gastroenterologists, colorectal surgeons, and general surgeons.

History

Ligation of hemorrhoids was first recorded by Hippocrates in 460 BC, who wrote about using thread to tie off hemorrhoids. [5]

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

Dr. Patrick J. O’Regan, a laparoscopic surgeon, invented the disposable CRH O’Regan System. In 1997, the ligator was approved by the FDA for the treatment of hemorrhoids. [6]

Procedure

Rubber band ligation procedure is as follows:

  1. Pre-treatment diagnosis and prescribed medications
    • A physician diagnoses the condition of hemorrhoids during a colonoscopy, or an anoscopy/proctoscopy
  2. Preparation
    • RBL does not require any patient preparation
  3. Positioning
    • The patient is generally placed on a proctology table in the kneeling position or, less commonly, on the left side on an exam table, with knees drawn up (fetal position)
  4. Application of the band
    • With traditional RBL, 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. Reusable instruments have also been available for many decades to use suction rather than forceps to draw tissue into the instrument so the rubber band can be deployed.
    • The CRH O'Regan ligation system also eliminates the use of forceps. It is much more expensive on a per-case basis than the reusable suction ligator. It is rarely used by full-time colon and rectal surgeons (Proctologists), but recently has been adopted by many Gastroenterologists to increase the revenue to their practice. The device applies gentle suction which allows the doctor to place a small rubber-band around the base of the hemorrhoid. [7] Three banding sessions are typically required at 2 week intervals for a complete treatment. More bands can be applied if the patient is under general anesthetic, although the recovery time may be prolonged and more painful.

Complications

Possible complications from rubber band ligation include:

Post-procedure instructions for patients

Related Research Articles

<span class="mw-page-title-main">Gastroenterology</span> Branch of medicine focused on the digestive system and its disorders

Gastroenterology is the branch of medicine focused on the digestive system and its disorders. The digestive system consists of the gastrointestinal tract, sometimes referred to as the GI tract, which includes the esophagus, stomach, small intestine and large intestine as well as the accessory organs of digestion which include the pancreas, gallbladder, and liver.

<span class="mw-page-title-main">Constipation</span> Bowel dysfunction

Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the bowel movement. Complications from constipation may include hemorrhoids, anal fissure or fecal impaction. The normal frequency of bowel movements in adults is between three per day and three per week. Babies often have three to four bowel movements per day while young children typically have two to three per day.

<span class="mw-page-title-main">Hemorrhoid</span> Vascular structures in the anal canal

Hemorrhoids, also known as piles, are vascular structures in the anal canal. In their normal state, they are cushions that help with stool control. They become a disease when swollen or inflamed; the unqualified term hemorrhoid is often used to refer to the disease. The signs and symptoms of hemorrhoids depend on the type present. Internal hemorrhoids often result in painless, bright red rectal bleeding when defecating. External hemorrhoids often result in pain and swelling in the area of the anus. If bleeding occurs, it is usually darker. Symptoms frequently get better after a few days. A skin tag may remain after the healing of an external hemorrhoid.

<span class="mw-page-title-main">Colonoscopy</span> Examination of the bowel

Colonoscopy or coloscopy is a medical procedure involving the endoscopic examination of the large bowel (colon) and the distal portion of the small bowel. This examination is performed using either a CCD camera or a fiber optic camera, which is mounted on a flexible tube and passed through the anus.

<span class="mw-page-title-main">Ligature (medicine)</span> Piece of thread (suture) tied around an anatomical structure

In surgery or medical procedure, a ligature consists of a piece of thread (suture) tied around an anatomical structure, usually a blood vessel, another hollow structure or an accessory skin tag to shut it off.

<span class="mw-page-title-main">Esophagogastroduodenoscopy</span> Diagnostic endoscopic procedure

Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered a minimally invasive procedure since it does not require an incision into one of the major body cavities and does not require any significant recovery after the procedure. However, a sore throat is common.

<span class="mw-page-title-main">Gastrointestinal bleeding</span> Medical condition

Gastrointestinal bleeding, also called gastrointestinal hemorrhage (GIB), is all forms of bleeding in the gastrointestinal tract, from the mouth to the rectum. When there is significant blood loss over a short time, symptoms may include vomiting red blood, vomiting black blood, bloody stool, or black stool. Small amounts of bleeding over a long time may cause iron-deficiency anemia resulting in feeling tired or heart-related chest pain. Other symptoms may include abdominal pain, shortness of breath, pale skin, or passing out. Sometimes in those with small amounts of bleeding no symptoms may be present.

<span class="mw-page-title-main">Colorectal surgery</span> Field in medicine for disabilities in the rectum

Colorectal surgery is a field in medicine dealing with disorders of the rectum, anus, and colon. The field is also known as proctology, but this term is now used infrequently within medicine and is most often employed to identify practices relating to the anus and rectum in particular. The word proctology is derived from the Greek words πρωκτός proktos, meaning "anus" or "hindparts", and -λογία -logia, meaning "science" or "study".

<span class="mw-page-title-main">Surgical instrument</span> Tools designed for use during surgery

A surgical instrument is a medical device for performing specific actions or carrying out desired effects during a surgery or operation, such as modifying biological tissue, or to provide access for viewing it. Over time, many different kinds of surgical instruments and tools have been invented. Some surgical instruments are designed for general use in all sorts of surgeries, while others are designed for only certain specialties or specific procedures.

<span class="mw-page-title-main">Blood in stool</span> Medical condition

Blood in stool or rectal bleeding looks different depending on how early it enters the digestive tract—and thus how much digestive action it has been exposed to—and how much there is. The term can refer either to melena, with a black appearance, typically originating from upper gastrointestinal bleeding; or to hematochezia, with a red color, typically originating from lower gastrointestinal bleeding. Evaluation of the blood found in stool depends on its characteristics, in terms of color, quantity and other features, which can point to its source, however, more serious conditions can present with a mixed picture, or with the form of bleeding that is found in another section of the tract. The term "blood in stool" is usually only used to describe visible blood, and not fecal occult blood, which is found only after physical examination and chemical laboratory testing.

Banding is a medical procedure which uses elastic bands for constriction. Banding may be used to tie off blood vessels in order to stop bleeding, as in the treatment of bleeding esophageal varices. The band restricts blood flow to the ligated tissue, so that it eventually dies and sloughs away from the supporting tissue. This same principle underlies banding as treatment for hemorrhoids.

Rectal bleeding refers to bleeding in the rectum. There are many causes of rectal hemorrhage, including inflamed hemorrhoids, rectal varices, proctitis, stercoral ulcers and infections. Diagnosis is usually made by proctoscopy, which is an endoscopic test.

The Bristol stool scale is a diagnostic medical tool designed to classify the form of human faeces into seven categories. It is used in both clinical and experimental fields.

<span class="mw-page-title-main">Anal fistula</span> Disease of the anus

Anal fistula is a chronic abnormal communication between the anal canal and the perianal skin. An anal fistula can be described as a narrow tunnel with its internal opening in the anal canal and its external opening in the skin near the anus. Anal fistulae commonly occur in people with a history of anal abscesses. They can form when anal abscesses do not heal properly.

<span class="mw-page-title-main">Diosmin</span> Chemical compound

Diosmin, a flavone glycoside of diosmetin, is manufactured from citrus fruit peels as a phlebotonic non-prescription dietary supplement used to aid treatment of hemorrhoids or chronic venous diseases, mainly of the legs.

<span class="mw-page-title-main">Stapled hemorrhoidopexy</span>

Stapled hemorrhoidopexy is a surgical procedure that involves the cutting and removal of anal hemorrhoidal vascular cushion, whose function is to help to seal stools and create continence. Procedure also removes abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. Severe cases of hemorrhoidal prolapse will normally require surgery. Newer surgical procedures include stapled transanal rectal resection (STARR) and procedure for prolapse and hemorrhoids (PPH). Both STARR and PPH are contraindicated in persons with either enterocele or anismus.

<span class="mw-page-title-main">Endoscopy unit</span>

An endoscopy unit refers to a dedicated area where medical procedures are performed with endoscopes, which are cameras used to visualize structures within the body, such as the digestive tract and genitourinary system. Endoscopy units may be located within a hospital, incorporated within other medical care centres, or may be stand-alone in nature.

Transanal hemorrhoidal dearterialization (THD) is a minimally invasive surgical procedure for the treatment of internal hemorrhoids.

Anorectal varices are the dilation of collateral submucosal vessels due to backflow in the veins of the rectum. Typically this occurs due to portal hypertension which shunts venous blood from the portal system through the portosystemic anastomosis present at this site into the systemic venous system. This can also occur in the esophagus, causing esophageal varices, and at the level of the umbilicus, causing caput medusae. Between 44% and 78% of patients with portal hypertension get anorectal varices.

In fecal incontinence (FI), surgery may be carried out if conservative measures alone are not sufficient to control symptoms. There are many surgical options described for FI, and they can be considered in 4 general groups.

References

  1. Brown, Steven R; Tiernan, James P; Watson, Angus J M; Biggs, Katie; Shephard, Neil; Wailoo, Allan J; Bradburn, Mike; Alshreef, Abualbishr; Hind, Daniel (July 2016). "Haemorrhoidal artery ligation versus rubber band ligation for the management of symptomatic second-degree and third-degree haemorrhoids (HubBLe): a multicentre, open-label, randomised controlled trial". The Lancet. 388 (10042): 356–364. doi:10.1016/S0140-6736(16)30584-0. ISSN   0140-6736. PMC   4956910 . PMID   27236344.
  2. Kumar, N.; Paulvannan, S.; Billings, P. J. (May 2002). "Rubber band ligation of haemorrhoids in the out-patient clinic". Annals of the Royal College of Surgeons of England. 84 (3): 172–174. PMC   2503822 . PMID   12092868.
  3. Mott, Timothy; Latimer, Kelly; Edwards, Chad (2018-02-01). "Hemorrhoids: Diagnosis and Treatment Options". American Family Physician. 97 (3): 172–179. ISSN   1532-0650. PMID   29431977.
  4. Cleator, Iain G.M.; Maria M. Cleator (April 2005). "Banding Hemorrhoids using the O'Regan Disposable Bander". U.S. Gastroenterology Review.
  5. Lohsiriwat, Varut (2015-08-21). "Treatment of hemorrhoids: A coloproctologist's view". World Journal of Gastroenterology. 21 (31): 9245–9252. doi: 10.3748/wjg.v21.i31.9245 . ISSN   2219-2840. PMC   4541377 . PMID   26309351.
  6. "About Us" . Retrieved 9 October 2013.
  7. "Recovering from Hemorrhoid Banding". CRH Medical Corporation. 8 May 2012.
  8. "What Hemorrhoid Treatments Can I Get in My Doctor's Office?".