Name of the Procedure:

Sigmoidoscopy, flexible; with band ligation(s) (e.g., hemorrhoids)

Summary

A flexible sigmoidoscopy with band ligation is a minimally invasive procedure used to examine the lower part of the colon (sigmoid colon) and to treat hemorrhoids using small rubber bands. This is conducted using a flexible tube with a camera.

Purpose

This procedure is performed to diagnose and treat hemorrhoids, which are swollen blood vessels in the rectal area. The goal is to alleviate symptoms such as bleeding, pain, and discomfort associated with hemorrhoids.

Indications

• Rectal bleeding
• Chronic anal pain
• Hemorrhoids that have not responded to conservative treatments like diet modification and medications
• Visible hemorrhoids
• Hemorrhoids causing prolapse outside the anus

Preparation

• Patients may be asked to follow a clear liquid diet for 24 hours before the procedure.
• Bowel preparation, such as using prescribed laxatives or enemas, is often required.
• Refrain from smoking and drinking alcohol.
• Discuss current medications with your doctor; some medications may need to be adjusted.

Procedure Description

1. Sedation: Patient may receive mild sedation or local anesthesia.
2. Insertion: A flexible sigmoidoscope is inserted through the anus to visualize the sigmoid colon.
3. Examination: The physician inspects the internal lining of the lower colon.
4. Band Ligation: If hemorrhoids are found, small rubber bands are placed around their base using a special instrument passed through the sigmoidoscope. This cuts off blood supply causing hemorrhoids to shrink and fall off.
5. Completion: The sigmoidoscope is carefully withdrawn, and the procedure is concluded.

Duration

The procedure typically lasts around 10-20 minutes.

Setting

The procedure is usually performed in an outpatient clinic, endoscopy center, or hospital.

Personnel

• Gastroenterologist or Colorectal Surgeon
• Nurses
• Anesthesiologist (if sedation is used)

Risks and Complications

• Mild discomfort or pain
• Bleeding from the treatment site
• Infection
• Perforation of the colon (rare)
• Adverse reactions to sedation

Benefits

• Relief from hemorrhoid symptoms
• Minimally invasive with quicker recovery time
• Can be performed on an outpatient basis

Recovery

• Patients may experience slight discomfort, which can be managed with over-the-counter pain medications.
• Resume normal activities in 24-48 hours but avoid heavy lifting and strenuous activities for a few days.
• Follow-up appointments may be necessary to monitor recovery and assess the need for further treatment.

Alternatives

• Conservative treatments: dietary changes, topical treatments, sitz baths
• Surgical hemorrhoidectomy (for severe cases)
• Sclerotherapy or infrared coagulation

Pros and Cons:

• Conservative treatments are less invasive but may be less effective.
• Surgical options are more invasive but may offer more permanent solutions.

Patient Experience

• Most patients report minimal pain during the procedure itself.
• Some discomfort and minor bleeding post-procedure are common.
• Pain management includes over-the-counter pain relievers and sitz baths.
• Patients generally return to normal activities within a day or two with minimal disruption to daily life.