Articole

Rubber-Band Ligation of Haemorrhoids

Rubber-Band Ligation of Haemorrhoids with rubber-bands is a procedure through which the basis of the haemorrhoid is ligated with rubber rings, this interrupting the blood flow towards the haemorrhoid. In order to perform this procedure, the physicians inserts an optical instrument (anoscope) into the anus. The haemorrhoid is pinched with a special instrument, and a device fits the rubber ring over the basis of the haemorrhoid. The haemorrhoid atrophies and falls off in approximately one week. A scar forms at the initial haemorrhoid site, so that the adjacent veins do not swell onto the anal canal.
The procedure is performed in a medical clinic. You will be asked whether the rubber bands are too tight. If the ligature causes pain, an anaesthetic can be injected into the haemorrhoid. After the procedure, you may feel pain and a fullness sensation in the lower abdomen or a fake defecation sensation. The treatment is limited to 1-2 haemorrhoids per sessions, if the procedure is performed in a medical practice. A larger number of haemorrhoids may be treated during the same session if the patient is under general anesthesia. The other haemorrhoidal areas will be treated after 4-6 weeks.
What To Expect After The Treatment:
Patients respond differently to this procedure. Some are able to resume their daily activities almost immediately (with the recommendation to avoid heavy lifting). Other may require 2-3 days of rest.

The pain is a common syndrome 24-48 hours after the ligation. You can use acetaminophen (e.g., Tylenol) and warm sitz baths to relieve discomfort.
In order to reduce the bleeding risk, avoid aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for 4-5 days before and after the ligation.
Bleeding may persist for 7-10 days after the procedure, when the haemorrhoid falls off. The bleeding generally is light and tends to disappear by itself.

Physicians recommend the use of fibre-content laxatives and liquid intake in order to facilitate defecation. The pressure during defecation may cause haemorrhoid relapse.
The Importance of This Type of Treatment:
Rubber-band ligation is widely used in the treatment of internal haemorrhoids. If the symptoms persist after 3-4 treatment sessions, surgical intervention might be required. Rubber-band ligation cannot be used if the removal device is unable to grasp (vacuum, pull) a sufficient quantity of tissue. This technique is almost never recommended for IV degree haemorrhoids.
Treatment Efficiency:
Rubber-band ligation is efficient in 7-9 out of 10 people opting for this technique. It is much less probable for the people opting for this treatment to require another technique, as compared to those using a coagulation treatment. Approximately 1 out of 10 people will require surgery.
Risks:
Though rare, secondary effects may include:

● Severe pain that does not respond to the post-procedural painkilling methods. The rubber bands may be placed close to the anal canal area hosting the pain sensory receptors;
● Anal bleeding;
● Urinary retention;
● Anal infection;

Remarks:
Rubber-band ligation is regarded as the most effective non-surgical long-term internal haemorrhoid treatment method. As this treatment may cause pain, some people may refrain from it. Even though other treatment methods may be less painful, they might not be as efficient, and a less efficient treatment might need to be resumed in the case of a relapse.
Haemorrhoidectomy can provide better long-term results than the fixative procedures, such as rubber-band ligation. However, the intervention is more expensive, requires a longer recovery time and has a higher associated risk of complications.

Stapled Mechanical Haemorrhoidectomy

Haemorrhoid treatments are classified into two groups. They may be treated using non-surgical or traditional methods and by surgical procedures. The physician decides on the specific treatment suitable for each patient, depending on the severity of the case. In severe cases, surgery is required. One of the surgical haemorrhoid resection methods is stapled mechanical haemorrhoidectomy. Some people might not be familiar with this procedure because of its various names. It is also known as PPH or the Procedure for Prolapse and Haemorrhoids. Other health specialists use the name of stapled haemorrhoidopexy or circumferential mucosectomy.
Procedure:
The method uses a circular stapling device to excise the excess tissue from the prolapsed anal mucous membrane. This device pulls the prolapsed tissue to allow the excess tissue to be removed while the remaining haemorrhoidal tissue is stapled. This restores the haemorrhoidal tissue back to its original anatomical position.

IR Haemorrhoid Coagulation

IR Haemorrhoid Coagulation (also referred to as coagulation therapy) is a medical procedure used to treat small- and medium-sized haemorrhoids. During the procedure, the doctor uses a device that generates an IR beam.
The heat generated by the IR beam causes the tissue to scar, which helps stop the blood flow towards the haemorrhoid. The haemorrhoid disappears, and the scar formed on the anal canal prevents the swelling of the anal canal vessels. Only one haemorrhoid can be treated per session. The other haemorrhoids may be treated after 10-14 days.

Haemorrhoid Diagnosis

Because haemorrhoid symptoms are similar to those of an anal fissure, a fistula or an anal abscess, it is very important that the diagnosis be set by a proctologist. However, most people treat haemorrhoids with OTC medication and without previously discussing the matter with the physician. Rectal bleeding, regardless of their cause, must be investigated by a physician. In order to diagnose haemorrhoids, the physician must check the anal area. The physician may also perform a digital rectal exam (DRE) using a sterile glove and lubricant. This exam might be unpleasant if the patient suffers from external haemorrhoids, but it is, however, useful to set a correct diagnosis.
In some cases, more detailed examination might impose the use of an anoscope. The anoscope is a cylindrical medical instrument, equipped with an optical system, which helps view internal haemorrhoids when placed inside the rectum.

Haemorrhoid Symptoms

Haemorrhoid symptoms may vary from one person to another, but there are a series of general symptoms that may be associated to this type of disease. Depending on the severity of the disease, haemorrhoids may be classified into four main categories, each with its own symptomatology:
1st Degree Haemorrhoids – they are generally associated to the presence of bleeding and pain, but they are not prolapsed.
2nd degree haemorrhoids – these haemorrhoids are prolapsed and may withdraw on their own (may be reducible), with or without bleeding.
The two categories above are regarded as less severe cases and allow for the use of non-invasive treatment methods in our clinics.
3rd degree haemorrhoids are prolapsed and they do not withdraw on their own, but, instead, need to be manually forced back into the anal canal, either by the patient or by the doctor.