This patient is an otherwise healthy 65 year-old woman who presented with complaints of perianal itching and bleeding. The patient had a recent colonoscopy which only showed hemorrhoidal disease, and she had no contraindication to band ligation. She had the left lateral and right anterior hemorrhoids banded successfully, and presented for banding of the right posterior (RP) column in order to complete her treatment. She saw dramatic improvement after the first two bandings, but some residual bleeding persisted.
When attempting to band the RP column, a series of “misfires” made the procedure more difficult than usual. We received a call regarding this patient and offered advice as to how best to complete the procedure, after which the patient was banded successfully.
There are a few technical “tips and tricks” that come in very handy when dealing with some patients’ right posterior hemorrhoids. First off, some folks’ rectal vaults are quite “voluminous” and so in order to oppose the hemorrhoidal tissue that we want to band, a much more severe angulation of the ligator is required. The most effective means of facilitating this is to make certain that the patient has flexed their hips so that BOTH knees are up towards their chest. Without this adjustment, it can be more difficult to get the ligator in the correct position in order to capture that RP hemorrhoidal tissue.
There are also some technical tips that make the ligator more effective in obtaining adequate tissue and subsequently deploying a band. These include “pumping” the plunger a few times before locking it in place, letting the locked ligator sit for a bit more time to allow for more tissue to creep up into the syringe, twisting the syringe a few times, and then finally by SLOWLY withdrawing the syringe from the overlying “band pusher”. If you deploy the band too quickly, you will hear a single “pop” sound and if you are doing it more appropriately, you will hear the “click” of the band deploying, followed by the “smooch” of the tissue disengaging as the syringe is pulled back a bit further.
These tips are demonstrated on a couple of videos in our tutorial series. PLEASE let us know if you experience issues such as these, as we are always looking for a good excuse to come visit your practice and to see how we can best support you in the treatment of your patients!
CRH Anesthesia Management Continues to Grow!
The past few weeks have been very exciting for us as CRH Anesthesia has reached agreements with groups in the Denver, Raleigh and San Antonio areas, bringing the number of ASCs we service to 35 in 7 states, doing an estimated 235,000 cases per year. CRH is still aggressively seeking to expand our footprint, so if you currently do not have an anesthesia program as a part of your practice, we’d love to speak with you about building one that you can benefit from. If you currently do have an anesthesia program and would like to learn both about its potential value as well as the various options that would allow you to both monetize some of your program’s value as well as to maximize its performance, we’d love to talk to you as well.
The ACG is Right Around the Corner!
For those of you traveling to Orlando for the ACG, we want to invite you to visit us in the Exhibition Hall at Booth #1321 on October 15-17. Andy Gorchynsky and I will be there to answer any questions that may have popped up as well as to demonstrate any of the “tips and tricks” we are touting. We’ll also have members of our anesthesia team there to provide any information you might need and we will be holding a contest for a chance to win an iPad. We hope to see you there!!
Thanks so much for checking in on this Bulletin! As always, please let ME know if any questions arise, or if we can provide any information or support for you or your practice. We would love the opportunity to help train any partners or friends, work with your midlevels, or talk to your “gut clubs” – anything that we can do in order to help the cause! Safe travels and we’ll hope to catch up with you again soon.