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Banding Bulletin – February 2013

Banding Bulletin – February 2013

Thanks for taking a look at this month’s “Banding Bulletin”! In this month’s edition, we’d like to remind you of some of the educational resources which we have made available to you on our physican’s website, as well as introduce you to a few new short videos which address some of the questions we frequently receive. We’ll also update you on our Conference Calendar and pass along an operational tip or two. As always, we are also looking for your feedback and suggestions as to how we can better support you and your staff to make life easier for everyone in your practice!

We are happy to introduce the first installments in our series of video tutorials!

We’ve now added to the Videos area of our website with the first 5 installments of our “Physician Tutorial Series”. Our aim is to have a selection of brief videos that respond to some of the more frequently asked questions we receive and to present some of the “tips and tricks” that we’ve identified in order to help you and your banding practice. The current episodes include:

• Loading the Ligator
• Unlocking the Plunger
• Using the CRH Slotted Anoscope
• Obtaining Adequate Tissue – this includes some tips that help to avoid
banding too little tissue.
• Contraindications — this is a bit longer discussion which covers the use
of anticoagulants as well as contraindications to banding.

We hope that you will find these resources helpful, and we’d like to encourage you to offer suggestions for other topics which you’d like us to cover in future episodes.

Communication is the key to having happy patients!

This may be restating the obvious, but experience demonstrates that an informed patient is much more likely to be a happy patient when it comes to the treatment of their hemorrhoids, or most anything else for that matter! Whether it comes from the appointment scheduler, front office, midlevels, referring partners or the provider — making certain that the patient understands the treatment process, and has a proper level of expectation for their results are key factors in obtaining patient satisfaction. Some of the more important points to ensure patients are aware of include:

• They have 3 hemorrhoidal columns, and the majority of patients will require all 3 areas treated in order to achieve a successful treatment outcome. The reason we treat one column at a time is to minimize the complications.

• Whether they receive symptomatic relief after the first visit or no improvement at all, it’s important to set the expectation that they probably need 3 treatments. Statistically, some 10 – 15% of patients will NOT need all 3 areas treated, and 15 – 20% will need more than 3 areas banded.

• If the patient has significant issues from more than 1 of their hemorrhoidal columns, they may well not see much difference in their symptoms after the first hemorrhoid is banded. You can increase your therapeutic yield from the first ligation if you identify the most likely offender, and “attack” it first. Diagnostic anoscopy just prior to banding is the quickest and easiest way to do this in the office.

• Internal hemorrhoid ligation will eliminate the SYMPTOMS from their hemorrhoids very effectively, and will eliminate the EXTERNAL SYMPTOMS roughly 90% of the time. Internal hemorrhoid ligation will NOT make all of the patients’ tags and external hemorrhoids disappear — this is NOT a cosmetic procedure! The patient should realize that RBL is a great tool to relieve the patients’ SYMPTOMS.

Making certain that your patients have this information before you begin treating them will eliminate the majority of the uncertainty that your patients might experience. Easy ways to provide this information include referring them to our patient website – – where there is a tremendous amount of information available, as well as to make certain that receptionists, schedulers and front office staff are familiar with the information above.

Should you want CRH to “in-service” your staff, or offer a “refresher” training for them, please contact Brianne, and she will set up a teleconference with your practice. Of course, we are also happy to schedule trainings or refreshers for any of the docs in your practice as well!

CRH “on the road”:

This month, we will be in Jacksonville, FL for the Southeastern Surgical Congress Annual Scientific Meeting, which is being held February 9th – 12th.

In March, we will be at the ACG/FGS Spring Symposium on Captiva Island, FL from the 1st through the 3rd, as well as at the GI Roundtable in Boston from the 15th through the 17th.

If you will be attending any of these conferences, please come by and say “hello”.

Thanks again for your continued interest and support! Please let us know if there is anything that we can do in order to help support you and your practice, and we hope to catch up with you soon.

Best regards,


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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