Rubber band ligation (hemorrhoids)
Rubber band ligation or rubber band ligation refers to a medical procedure for the treatment of hemorrhoids discomfort.
Field of application (indication)
For 1st degree hemorrhoids , the procedure is an alternative to sclerotherapy . This procedure is ideal for the treatment of hemorrhoids, especially 2nd degree. Because of the low chance of success with third-degree hemorrhoids, it is usually only used if there are important reasons against an operation.
technology
Therapy is carried out after the rectum has been cleaned with an enema through a rigid rectal tube ( proctoscope ). A rubber band is applied to the foot of the hemorrhoid using an applicator with suction. This constricts the protruding (prolapsing) part and prevents the local blood flow. Complete thrombotic occlusion of the vessel occurs after two to three days. After a few days, the constricted tissue part dies and is excreted with the stool, along with the elastic band, unnoticed.
The procedure is inexpensive and relatively easy to carry out on an outpatient basis . Usually the treatment does not cause pain, so anesthesia is not required.
course
The treatment usually takes place in several sessions about four weeks apart, as it cannot be performed on all nodes at the same time. The knot and elastic band are loosened over a period of about 7-10 days (exceptionally more) and then heal a few days later.
After the tied off hemorrhoids fall off, an ulcer develops , which creates a scar in the mucous membrane. This scar is supposed to prevent recanalization (reopening) of the hemorrhoids. In contrast to the sclerotherapy or surgical methods, the scars are much flatter.
An improvement in the hemorrhoid symptoms occurs relatively soon after the procedure with a very high success rate and the patient recovers very quickly from the treatment.
Risks and Complications
The risks of the mostly harmless treatment exist when taking "blood-thinning" drugs (secondary bleeding) and latex allergies (rarely serious, allergic reactions) as well as chronic inflammatory bowel diseases (fistula formation) and infections.
When the ulcer develops, bleeding, usually minor, can occur. Heavy bleeding occurs in 0.5% of cases and must be stopped endoscopically. Occasionally there is intermittent pain.
As with all interventions, there is also a low risk of injury or infection due to the surgeon's carelessness .
Recurrences
The recurrence rate depends heavily on the behavior and diet of the patient. If he maintains bad habits, symptoms will reappear after a while. On average, after successful eradication , a relapse rate of 30 to 50% can be expected within five years.
history
The modern rubber band ligature was introduced by Blaisdell in the 1950s and later further developed and technically refined by Barron by introducing a mechanical instrument, the Barron ligator .
However, there are already from the 5th century BC Chr. Reports of such a procedure at Hippocrates .
literature
- D MacKay: Hemorrhoids and varicose veins: a review of treatment options . (PDF, 377 kB) In: Altern Med Rev . , 2001 Apr, 6 (2), pp. 126-140. Review. PMID 11302778
