Rubber band ligation with and without injection - The Procedure

A SIMULATED PROCEDURE

INDICATIONS

1. All types of internal haemorrhoids
2. Prolapsing mucosa
3. To stop bleeding from a localised mucosal area

CONTRAINDICATIONS

1. The treatment of other colonic or ano rectal diseases usually takes precedence over that of haemorrhoids.
   
   THE DIAGNOSIS OF CANCER OF THE BOWEL OR POLYPS MUST BE EXCLUDED BY COLONOSCOPY IN PATIENTS OVER 35 YEARS OF AGE.
   
   If necessary, The Wales Day Centre (Sydney)will do this for you.
   
2. Anal pain and sphincter spasm must be eliminated before treatment.

ASSISTANCE

An assistant is useful, but if necessary the patient can hold the proctoscope in position as shown here.

BOWEL PREPARATION - Nil
SEDATION - Nil
ANAESTHESIA - Nil
POSITION OF PATIENT - Left lateral position

INSTRUMENTS AND MATERIALS

• Banding instrument (shown above)
• Proctoscope
• Lubricant
• Grasping forceps
• Rubber bands
• Loading cone
• Forceps and cotton wool to wipe away faeces
• Satisfactory illumination

1. One or two rubber bands are loaded onto the drum of the banding instrument, using the loading cone. An attached thread is useful if the band must be removed from the anal canal if pain ensues.
   
   
   
2. The loading cone is removed
   
3. The lubricated proctoscope is inserted into the anus and guided into position with the relevant pile prolapsing over the rim of the appliance.
   
4. The proctoscope handle is presented to the patient or the assistant.
   
   
   
5. The grasping forceps are threaded through the drum of the banding instrument.
   
   
   
   Full view of banding instrument with grasping forceps threaded through drum. Note: thread attached to rubber band to withdraw band if neccessary.
   
   
   
6. The haemorrhoid is grasped at least 7mm above the dentate line.
   
   
   
7. Whilst the other hand is used to grip the ligator, its drums are passed over the haemorrhoid ensuring that the dentate line is at least 2mm below the drum.
   
   
   
8. The trigger mechanism is compressed to release the band or bands onto the pile.
   
9. The proctoscope is removed and the thread is cut short.
   
   
   
   The picture above shows the final stage of the banding procedure prior to cutting the thread.

RUBBER BAND LIGATION WITH INJECTION

Injection of 1cc 5% phenol in almond oil (obtainable in ampoules) into the submucosa deep to the ligated haemorrhoid is often useful.

After injection, the mucosa is seen to bulge.

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