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Banding Bulletin – December 2011

Banding Bulletin – December 2011

It seems inconceivable that the Holidays are upon us again! It feels like just yesterday we were “closing out” 2010! 2011 was a busy and terrific year for Andy and me; we had a chance to participate in approximately 240 training sessions around the country. 2012 will be picking up right where 2011 left off, as it looks as if our frequent flyer status is safe for another year!


We are in the process of finalizing our meeting calendars for 2012. We are currently scheduled to attend DDW, The American College of Gastroenterology and The American College of Surgeons national meetings, along with a number of regional meetings. Our first conference will be the regional ACG meeting in Huntington Beach, CA on January 27-29, 2012 and we’ll hope to you see there. We are also looking to work with your local/regional “Gut Clubs” as well as any Fellowship Programs that would like to introduce anorectal care to their curriculum. Jack Di Palma from the Univ. of South Alabama in Mobile wrote a very nice article in the May edition of Practical Gastroenterology touting the benefits of adding this type of material for GI fellows. We are happy to present lectures and other information in a very “non-proprietary” manner to help you to get this information introduced. We aslo include “hands-on” training for any interested attending staff and fellows. Please contact ME if you have any questions, or if you would like to schedule such a session.


Looking statistically at the results obtained from Dr. Cleator as well as those from our own clinics and Partner practices, we find that there is a small percentage of patients (probably 10 – 15%) in whom symptoms have resolved with fewer than 3 bandings. There are also a number of patients (in the range of 15 – 20%) where 3 bandings are not quite enough to eliminate the problem. We’ve received a few questions and comments regarding the patient that may still have some symptoms after being banded in each hemorrhoidal area, so I’d like to address these in this edition of the “Banding Bulletin”.

One of the most frequent reasons for persistent bleeding after three bandings, particularly in the patient with symptoms of discomfort on defecation, is a missed anal fissure. Not all fissures are the “hyper-acute” types where severe pain is elicited on physical exam — many others are in various stages of healing, and an incompletely healed fissure may well “break open” after a bowel movement, causing bleeding. We are big fans of using 0.125% NTG ointment in the treatment of these patients. We typically prescribe a “pea sized” amount, PR, TID or QID, for use up to 3 months. There are several precautions to keep in mind, and we have our “Nitroglycerin Information Sheet” to give to patients in the Clinical Forms section of our website.

With the understanding that persistent symptoms may be multi-factorial, we have found that 15 – 20% of patients will need an additional band — typically not a “re-banding” of a previously treated area, but rather a banding of a “minor” pile, or some additional prolapsing tissue found between the previously placed bands. The additional banding will typically take care of the remaining hemorrhoidal issues, so please do not be discouraged in those few patients where 3 bands are not enough! Experience in our clinics has shown that 99% of symptomatic hemorrhoid patients can be treated using the CRH O’Regan System, with greater than a 95% success rate. These tremendous results, along with the positive response received from our patients, are what keep us this enthusiastic about the CRH Technology and techniques!


CRH is redoubling its efforts to work with your office in order to help make the care of hemorrhoids and other anorectal issues a more important part of your practice. We are happy to help your front and back offices from an operational perspective as well as to help you “spread the word” to prospective patients and referring physicians with a host of marketing resources all offered at no cost! We have been overwhelmed by the success of our patient-oriented website ( where in excess of 30,000 unique visitors explore our site on a monthly basis, and over 2,000 patients per month reach out to contact one of our Partner practices! This is proving to be a phenomenal resource for patients, as the demand for these services truly is remarkable. For marketing information, please contact Jennifer and she will help to work with you and your practice into the New Year.

As always, if there are any other topics which you would like us to touch on, or if a visit to your practice would be helpful — for either a “refresher” session, or for the training of a new physician, please let us know. There is no cost to you for the visit, and by allowing us to come to your Center, it will keep Andy and me out of our wives’ hair, making life more pleasant for everyone! We currently have very limited availability at the end of January, and are scheduling visits in February and beyond.

Finally, speaking for Andy and the rest of the team at CRH, we’d like to thank everyone for their interest and support! 2011 has been a great year, and we look forward to working with each of you in ’12 and beyond! We’d like to take this opportunity to wish you and yours a fantastic Holiday Season, along with all the best in the New Year. Take care, and we hope to catch up with you soon!



Mitchel Guttenplan, MD, FACS

Medical Director

CRH Medical Corporation

T: 800.660.2153 x1022 | C: 770.363.0125 | F: 770.475.9953

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