Internal Hemorrhoidal Treatment
Internal hemorrhoidal treatment options are based on symptoms and the grade of hemorrhoid ranging from I-III. Mild cases are treated with sitz bath, suppositories and stool softeners. However internal hemorrhoids that remain prolapsed are treated more aggressively. Due to the low recurrence and complication rate of rubber band ligation, it is the most widely used technique out of the other nonsurgical treatment options which include infrared coagulation, laser photocoagulation, and sclerotherapy. Rubberband ligation can be performed with or without an endoscope.
There are several nonendoscopic rubber band ligation devices used by gastroenterologists such as the ShortShot Saeed Hemorrhoidal Multi-Band Ligator by Cook Medical or the CRH O’Regan Disposable Hemorrhoidal Banding System by CRH Medical Group. The only device specifically marketed for endoscopic band ligation of hemorrhoids is the Stiegmann-Goff Bandito Endoscopic Hemorrhoidal Ligator by ConMed Corp.
Treatment of Internal Hemorrhoids
During an outpatient procedure, a proctoscope is inserted into the anal opening to identify the hemorrhoids. Suction from the CRH O’Regan System is used to grasp the hemorrhoid and draw it into the ligator. A rubber band is then applied around the base of the hemorrhoid. The application of a rubber band stops the flow of blood to the tissue which will eventually shrink and fall off. The procedure may be repeated based on the size and numer of hemorrhoids present. This fast and generally painless procedure is an innovative approach to the treatment of internal hemorrhoids.
Hemorrhoids
Hemorrhoids are extremely common lesions within the anorectal area. They are enlarged veins also known as variceal dilations that occur as a result of persistently elevated pressure within the hemorrhoidal plexus. Risk factors for hemorrhoids include constipation that results in straining with bowel movements and pregnancy induced venous stasis. External hemorrhoids develop below the anorectal line and internal hemorrhoids develop above the anorectal line affecting the inferior and superior hemorrhoidal plexus respectively.
CRH O’Regan System
The CRH O’Regan System is a single use disposable suction ligator used for rubberband ligation of internal hemorrhoids. Once the hemorrhoidal tissue is suctioned into the ligator the rubber band is deployed around the base. The disposable device lessens the risk of acquired infections and pain since it does not involve the use of metal clamps and forceps as with traditional banding procedures. One banding takes about 60 seconds allowing for several treatment sessions to occur during the procedure. In contrast, traditional banding procedures take 5-10 minutes. Also, use of the CRH O’Regan System does not require the use of an endoscope which means sedation, fasting, and bowel prep is not required as with endoscopic hemorrhoidal banding.
