Hemorrhoid Coagulation

1. See Also
   1. Internal Hemorrhoid
2. Indications
   1. Indicated for Grades I to III Internal Hemorrhoid
      1. Most commonly used newer device
   2. Other uses
      1. Wart Treatment
      2. Tattoos removal
3. Advantages
   1. Quick and inexpensive
   2. No known Incidence of perineal Sepsis
   3. Less painful than Rubber Band ligation
4. Disadvantages
   1. Less effective on Grade III Hemorrhoids
   2. Not effective on Grade IV Hemorrhoids
   3. Failure rate is 4 fold over that of Rubber Band ligation
5. Initial Expense
   1. Device cost $2500
6. Mechanism
   1. Probe causes ulceration, scarring, tethering of mucosa
   2. Hemorrhoidal Vessels coagulated
7. Technique
   1. Insert Anoscope
      1. Identify most advanced Hemorrhoid complex
   2. Place tip of instrument at Hemorrhoid base (proximal)
      1. Apply 1.5 seconds per application
      2. Repeat for 4-5 applications per Hemorrhoid
      3. Apply several places along Hemorrhoid
   3. Recommend performing only one quadrant per visit
      1. Patient returns in 3-4 weeks for a second quadrant
8. Efficacy
   1. Rectal bleeding relieved in 90%
   2. Symptom free
      1. At 3 months: 80%
      2. At 1-4 years post-treatment: 40%
   3. Prolapse twice as likely at 1 year as with banding