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Rubber band ligation | |
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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.
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.
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]
Rubber band ligation procedure is as follows:
Possible complications from rubber band ligation include:
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.
Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.
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.
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.
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.
Digital rectal examination (DRE), also known as a prostate exam, is an internal examination of the rectum performed by a healthcare provider.
A rectal prolapse occurs when walls of the rectum have prolapsed to such a degree that they protrude out of the anus and are visible outside the body. However, most researchers agree that there are 3 to 5 different types of rectal prolapse, depending on whether the prolapsed section is visible externally, and whether the full or only partial thickness of the rectal wall is involved.
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.
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".
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.
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.
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.
Fecal microbiota transplant (FMT), also known as a stool transplant, is the process of transferring fecal bacteria and other microbes from a healthy individual into another individual. FMT is an effective treatment for Clostridioides difficile infection (CDI). For recurrent CDI, FMT is more effective than vancomycin alone, and may improve the outcome after the first index infection.
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.
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.
Capsule endoscopy is a medical procedure used to record internal images of the gastrointestinal tract for use in disease diagnosis. Newer developments are also able to take biopsies and release medication at specific locations of the entire gastrointestinal tract. Unlike the more widely used endoscope, capsule endoscopy provides the ability to see the middle portion of the small intestine. It can be applied to the detection of various gastrointestinal cancers, digestive diseases, ulcers, unexplained bleedings, and general abdominal pains. After a patient swallows the capsule, it passes along the gastrointestinal tract, taking a number of images per second which are transmitted wirelessly to an array of receivers connected to a portable recording device carried by the patient. General advantages of capsule endoscopy over standard endoscopy include the minimally invasive procedure setup, ability to visualize more of the gastrointestinal tract, and lower cost of the procedure.
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 collateral submucosal blood vessels dilated by 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.