When members of our clinical team visit practices across the country, all too often we run into patients that are not “ready” for banding. The most frequent scenario is a patient who exhibits a lot of tenderness at the time of their DRE, requiring at least a couple of weeks of treatment for their previously undiagnosed fissure before banding can commence. These patients typically had those same issues when they presented for their colonoscopy a few weeks prior, but were
For a complete review of the DRE please see our VIDEOS PAGE, but suffice it to say that generally speaking, if the patient is tender at the introitus, and if they do not have an abscess, fistula, or thrombosed external hemorrhoid, they most likely have a fissure! Empirically treating that fissure will likely have your patient ready to go when they come back to your clinic for banding.
In our clinics, we would typically do an anoscopic exam at the time of the patient’s first banding treatment. Since these patients are not prepped, you will occasionally run into a difficult exam because of retained stool, but you usually can see everything that you need to form a plan of treatment. For those patients in whom a satisfactory exam was performed, if I document things appropriately, I will not need to repeat that part of the examination at the time of the next visit. It has been shown that multiple bandings or multiple passages of instruments leads to a higher incidence of post banding pain, which is why we only band a single hemorrhoid per session, and utilize the anoscope on only the first visit (assuming a satisfactory exam).
It is just as important to minimize trauma to the tissue, particularly to the anoderm, as this causes immediate pain and is likely to further increase post-banding pain and patient complaints. The beveled (non-slotted) anoscope gives a great view of things with minimal disruption, and use of the CRH O’Regan System® with its integrated obturator and “anti-pinch” technology dramatically eases the insertion of the device and avoids trauma to the anal canal – affording (by far) the greatest patient satisfaction numbers available in the literature!
Your anorectal patients almost uniformly present with an incorrect set of expectations when it comes to their hemorrhoids and the care that they are about to receive. By spending a minute or two educating the patient, you will get those expectations in line with reality, leading to greater patient satisfaction and fewer post-treatment issues. These “spiels” are contained in the videos section, but they can be boiled down to:
Incorporating these speeches into your practice will help to assure a happy patient at the end of their treatment.
If you’re going to be at GI Roundtable in Seattle, please stop by our booth where I’d love to say “hi” and address any questions you may have about hemorrhoid banding with the CRH O’Regan System®.
I will be joined by some folks from our CRH Anesthesia team including Carter Blanton, VP of Business Development and Beemal Shah, SVP of Operations and would be happy to make an introduction if you’re interested in learning more about our flexible partnership models.
In January, CRH Anesthesia was proud to announce its most recent transaction (our 21st!), bringing the number of ASCs we serve to 47 in 11 states, and the number of cases to more than 320,000 per year.
If you currently have your own anesthesia service, we’d love to show you how we can both increase its value as well as to allow you to realize some of the equity that you’ve built into the program. If you currently outsource your anesthesia or if you are currently using conscious sedation and would like to build a deep sedation program, we’d love to help. Please contact CARTER BLANTON (our VP of Business Development) or ME and we can get the conversation started.