High macro rubber band ligature

Abstract

Purpose The goal of a rubber band ligature is to promote fibrosis of the submucosa with subsequent fixation of the anal epithelium to the underlying sphincter. Following this principle, a new technique of ligature was developed based on two aspects:1. macro banding: to have a better fibrosis and fixation by banding a bigger volume of mucosa and2. higher ligature: to have this fixation at the origin of the hemorrhoidal cushion displacement. Methods 1634 patients with internal hemorrhoidal disease grade II or III were treated by the technique called high macro rubber band. There was no distinction as to age, gender or race. To perform this technique a new hemorrhoidal device was specially designed with a larger diameter and a bigger capacity for mucosal volume aspiration. It is recommended to utilize a longer and wider anoscope to obtain a better view of the anal canal, which will facilitate the injection of submucosa higher in the anal canal and the insertion of the rubber band device. The hemorrhoidal cushion must be banded higher in the anal canal (4 cm above the pectinate line). It is preferable to treat all the hemorrhoids in one single session (maximum of three areas banded). Results The analysis was retrospective without any comparison with conventional banding. The period of evaluation extended from one to twelve years. The analysis of the results showed perianal edema in 1.6% of the patients, immediate tenesmus in 0.8%, intense pain (need for parenteral analgesia) in 1.6%, urinary retention in 0.1% of the patients and a symptomatic recurrence rate of 4.2%. All patients with symptomatic recurrence were treated with a new session of macro rubber banding. None of the patients developed anal or rectal sepsis. Small post-ligature bleeding was observed only in 0.8% of the patients. Conclusions The high macro rubber banding technique represents an alternative method for the treatment of hemorrhoidal disease grades II or III, with good results at a low cost. The analysis of the observed results showed a small incidence of minor complications, with a high index of symptomatic relief.

A New Classification for Hemorrhoidal Disease: The Creation of the “BPRST” Staging and Its Application in Clinical Practice

“…This difference influences not only symptomatology but also the management of these cases [3,5,8]. Taking as an example the stage II (reducible) hemorrhoids, the prolapses restricted to 1 or 2 piles can be successfully treated in a single office procedure (such as rubber-band ligation), whereas circumferential prolapses mostly require more than 1 session of ligation (or better nonanodermal excision surgical procedures) [13,14,20,21].…”

“…Stage I includes patients with bleeding, with no report of prolapse or external components (fibrotic skin tags or thrombosed piles) detectable on physical examination. For these patients, clinical measures (such as lifestyle modifications) are proposed; dietary fiber supplementation, increased water intake, physical activities, or sitz baths [12][13][14]. Outpatient interventions such as rubber-band ligation, infrared photocoagulation, or sclerotherapy are also indicated on an individual basis [13][14][15][16].…”

“…Stage II comprises patients with prolapse (whether circumferential or not, regardless of the number of prolapsed piles) that can be reduced spontaneously or by digital maneuver [6,8]. For these patients, it is feasible to adopt the strategies taken for patients with stage I HD (especially outpatient procedures, also highlighting the possibility of using the high-macro rubber-band macroligation procedure) [13], although the use of nonexcisional surgical treatments should be considered; mechanical stapled anopexy (procedure for prolapse and hemorrhoids) [17], transanal hemorrhoidal dearterialization (THD) [18], and radiofrequency ablation [19]. We highlight these treatment options for those with circumferential prolapse, once it is possible to treat all prolapsed piles in a single procedure, differently from rubber-band ligation that requires more than one procedure for that [20].…”

Hemorroides circunferenciales ¿cuál es la mejor opción?

“…En su estudio retrospectivo de 1634 pacientes grado II y III, informa una recidiva de 4,2 % con seguimiento de un año. 4 Con respecto a las técnicas de desarterialización Doppler (DGHAL) y (THD), se han realizado importantes trial randomizados, prospectivos y comparativos. En Reino Unido el multicéntrico (HubBle) que incluyó 350 pacientes, grado II y III, comparándola con bandas.…”