Hemorrhoidectomy, internal, by rubber band ligation(s)
CPT4 code
Name of the Procedure:
Hemorrhoidectomy, Internal, by Rubber Band Ligation (RBL)
Summary
Rubber band ligation is a minimally invasive procedure used to treat internal hemorrhoids. A small elastic band is placed around the base of the hemorrhoid to cut off its blood supply, causing it to shrink and fall off within a week.
Purpose
This procedure is used to treat symptomatic internal hemorrhoids, which are swollen veins in the rectum. The primary goals are to alleviate pain, itching, and bleeding associated with hemorrhoids and to prevent recurrence.
Indications
- Persistent bleeding from internal hemorrhoids
- Prolapsed hemorrhoids that do not retract on their own
- Hemorrhoidal pain that does not respond to conservative treatments
- Chronic irritation or itching around the anus
- Failure of other non-surgical treatments (e.g., dietary changes, topical medications)
Preparation
- Patients may be advised to fast for a few hours before the procedure.
- A clean enema or laxative may be recommended to empty the bowel.
- Adjustment or temporary discontinuation of certain medications (e.g., blood thinners) may be necessary.
- A physical examination and possibly a sigmoidoscopy or colonoscopy to evaluate the extent of the hemorrhoids.
Procedure Description
- The patient is positioned and a lubricated anoscope is inserted into the rectum to view the hemorrhoids.
- A specialized tool called a ligator is used to place a tight rubber band around the base of each hemorrhoid.
- This band cuts off the blood flow, causing the hemorrhoid to shrink and eventually detach.
- The procedure is typically performed without anesthesia, but mild sedation may be used.
Duration
The procedure typically takes about 15 to 30 minutes.
Setting
Rubber band ligation is usually performed in an outpatient clinic or office setting.
Personnel
- Gastroenterologist or colorectal surgeon
- Medical assistant or nurse
Risks and Complications
- Discomfort or mild pain following the procedure
- Bleeding, which can be managed with conservative measures
- Infection, although rare, may require antibiotics
- Urinary retention
- Thrombosed hemorrhoid, a severely painful condition that may require further treatment
Benefits
- Relief from hemorrhoidal symptoms
- Minimal invasive nature with quick recovery time
- Effective for most people, with improvement noticed within a few days to a week
Recovery
- Avoid lifting heavy objects or straining during bowel movements for a few days.
- Use of over-the-counter pain relievers as recommended
- High-fiber diet and increased fluid intake to maintain soft stools
- Follow-up appointment within a few weeks to assess treatment success
Alternatives
- Conservative management with dietary changes and topical treatments
- Sclerotherapy, where a chemical solution is injected into hemorrhoidal tissue
- Infrared coagulation, which uses infrared light to shrink hemorrhoids
- Surgical hemorrhoidectomy for more severe cases Each alternative has its own pros and cons, with factors like procedure invasiveness, effectiveness, and recovery time to be considered.
Patient Experience
During the procedure, patients might feel slight discomfort but it is generally well-tolerated. Post-procedure, there may be mild pain or a feeling of fullness in the rectum. Pain can be managed with medications, and symptoms usually improve within a few days.