II. Indications

  1. Grades I to III Internal Hemorrhoid

III. General

  1. Device Cost: $200-300

IV. Complications

  1. Postoperative Hemorrhage (2.8%)
    1. Stop Anticoagulants including Aspirin 5-7 days before procedure
  2. Thrombosed Hemorrhoid (1.5%)
  3. Vasovagal response
  4. Perirectal Abscess
  5. Rectal discharge may be a problem
  6. Bacteremia (0.09%)
    1. Perineal Sepsis risk (rare, but deaths have occurred)
    2. Presentation
      1. Rectal Pain
      2. Fever
      3. Inability to void
    3. Reference
      1. Russell (1989) Dis Colon Rect 28:291 [PubMed]

V. Disadvantages

  1. Needs 2 people to perform
  2. More painful than Infrared Coagulation

VI. Advantages

  1. More effective than Infrared Coagulation by 4 fold

VII. Technique

  1. Place 2 Rubber bands on ligator over top of cone
    1. Lubricate cone and bands with soapy water
  2. Position Anoscope for good visualization of Hemorrhoid
    1. Confirm not below Dentate Line (External Hemorrhoid)
  3. Insert ligator and pull Hemorrhoid through channel
    1. Be careful not to pull too much
  4. Release bands
  5. Only treat 1-2 Hemorrhoids per visit
  6. Additional bands can be placed in 4-6 weeks

VIII. Efficacy

  1. Overall success rate: 71%
  2. Completely symptom free on long term follow-up: 40-50%
  3. Iyer (2004) Dis Colon Rectum 47:1364 [PubMed]

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