0249T Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance

Name of the Procedure:

Ligation of Hemorrhoidal Vascular Bundle(s), Including Ultrasound Guidance

Summary

This procedure involves using ultrasound technology to locate and tie off (ligate) the blood vessels that supply hemorrhoids, which are swollen veins in the lower rectum or anus.

Purpose

The procedure aims to reduce or eliminate hemorrhoidal symptoms such as pain, bleeding, itching, and swelling. By cutting off the blood supply, the hemorrhoids shrink and symptoms improve.

Indications

• Persistent or severe hemorrhoidal symptoms that don't respond to conservative treatments (e.g., diet changes, over-the-counter creams)
• Recurrent hemorrhoidal bleeding
• Significant discomfort or pain due to hemorrhoids
• Prolapsed hemorrhoids that cannot be manually reduced

Preparation

• Fasting may be required for a few hours before the procedure.
• Patients may need to stop taking certain medications, such as blood thinners, as directed by their healthcare provider.
• Pre-procedure assessments, including a physical examination and possibly imaging studies, may be conducted.

Procedure Description

1. The patient is positioned appropriately, usually in a lithotomy or prone position.
2. Local anesthesia or sedation may be administered to minimize discomfort.
3. An ultrasound probe is inserted into the rectum to visualize the hemorrhoidal blood vessels.
4. Once identified, the vascular bundles supplying the hemorrhoids are ligated using a special device or sutures.
5. The ultrasound guidance ensures precise targeting and effective ligation.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

This procedure is usually performed in an outpatient clinic, surgical center, or sometimes in a hospital setting.

Personnel

• A colorectal surgeon or a specially trained healthcare provider
• Anesthesiologist or nurse anesthetist (if sedation or anesthesia is used)
• Nursing staff to assist with the procedure and patient care

Risks and Complications

• Mild bleeding or discomfort post-procedure
• Infection at the site of ligation
• Rarely, urinary retention or difficulty with bowel movements
• Incomplete ligation requiring follow-up treatment

Benefits

• Relief from hemorrhoidal symptoms like pain, bleeding, and swelling.
• Minimally invasive with a relatively quick recovery time.
• Effective in treating hemorrhoids that have not responded to other treatments.

Recovery

• Patients can usually go home the same day.
• Mild discomfort or soreness is common and can be managed with over-the-counter pain relievers.
• Instructions may include soaking in warm baths, maintaining a high-fiber diet, and avoiding strenuous activities for a few days.
• Follow-up appointments are recommended to monitor recovery.

Alternatives

• Conservative treatments (e.g., dietary changes, topical treatments)
• Rubber band ligation
• Sclerotherapy (injection of a hardening agent)
• Surgical hemorrhoidectomy
• Each alternative has varying success rates, recovery times, and associated risks.

Patient Experience

• Patients may feel some pressure or mild discomfort during the procedure, typically minimized by anesthesia.
• Post-procedure pain is usually mild, with some possible swelling or bleeding.
• Most patients can resume normal activities within a few days, with significant symptom relief expected after a week or two.