Barran Band Ligation
What is rubber band ligation/Barran band ligation?
Rubber bend ligation or Barran band ligation or it is often called is a non-surgical ambulatory procedure to treat second degree hemorrhoids/Piles & some third degree hemorrhoid/Piles. It is a process in which is tied off at its base by a rubber band stropping the blood flow of Hemorrhoids.
How it is done?
This procedure is usually performed as an out door patient procedure without anesthesia. An instrument whish facilitates the viewing of the anal canal (Proctoscope) is introduced in the anus & the hemorrhoid mass located. A rubber band is placed around the base of the Hemorrhoids with the help of a special instrument, cutting off the blood supply to the hemorrhoids .The hemorrhoids then shrinks, shrivels up, dies & ultimately falls off within 7 to 10 days leaving some scar tissue which support the veins in the area. Preventing them to distend or bulge in to the cavity.
Rubber Band Ligation of Internal Hemmorrhoid
( Endoscopic View )
Can all Hemorrhoids be treated by Band ligation? .... No,
- It is not convenient to treat 1 st degree Hemorrhoids by this method because there is insufficient tissue available to pull into the instrument for ligation.
- This is also not choice of treatment for third degrees Hemorrhoids require hemorrhoidectomy for permanent solution.
- This method is best suited for is now universally accepted as the choice of treatment for second degree hemorrhoids with normal or almost normal perennial skin. (Small, uncomplicated, not protruding piles).
Your status after the procedure
Though the band ligation procedure is virtually a painless procedure, many patients experience some degree of pain for 24 to 48 hours. This is usually relieved by painkillers. In some cases however it is required to inject local anesthetics medicine at the base of the ligated hemorrhoids to numb area. The onset of pain is immediately after the band ligation and is caused if ,
- The band is too near the areas which have lit of pain sensor. Or
- The band is ligated too deep, consequently including some sphincter muscles inside the ligated part of the hemorrhoids.
- Another main condition is the feeling of fullness or heaviness in the rectum or lower abdomen.
- Feeling of incomplete evacuation.
- A persistent feeling of the need for bowel movement.
- A little bleeding may occur 7 to 10 days after surgery when the minimal & stops by itself.
- Sometimes there may be temporary urine retention
A certain degree of discomfort which is usually relieved by our panchwalcal herbal decoction sitz bath. (Avgah sweda)
What extra care is to betaken for better results?
- Patient should not strain while passing stool. Straining increases possibility of recurrence.
- The patient should take a diet-rich in fiber contents & & fluids, so that the stool is soft, formed, compressible & hence easy to expel.
- Patient should not repress the need to pass stool, to fear of pain because this causes the stool to become hard which does not pass easily. Hard stool necessitates straining and also causes pain.
- Patient is advised to take sitz bath (warm water) to be reducing pain & discomfort.
- Patients are advised to avoid aspirin from a few days prior to banding to a few days after the hemorrhoid has fallen off.
Risks are rare but include.
- Severe pain which does not respond to pain killers is usually due to faulty placement of the band. In such a case the band has to be removed.
- Severe bleeding is very rare but may happen. This requires immediate ligation of the blood vessel.
- In rare cases there may develop pelvic infection which has to be duly treated. This associated with fever, increased pain & urine retention
- Secondary thrombosis of external hemorrhoids.
- It is one of the least expensive & most simple, safe, & effective solutions for 2 nd degree hemorrhoids.
- The procedure does not require hospitalization
- Can be performed without anesthesia.
- The patient is usually able to resume his daily routine immediately.
- There is minimum pain
- Even the external hemorrhoids mar reduce in size after ligation of the internal hemorrhoids
- Offer term solution compared to infrared photocoagulation therapy.
- Surgery is still possible if there is recurrence.
- Not very successful for large hemorrhoids.
- The procedure does nothing to remove the skin covered component of the pile which later may have to be excised under local anesthesia.
- May require more then one sitting since usually one or two hemorrhoids are ligated at a time.