Hemorrhoids: Eastic ligation. An alternative from the surgeon

There are many situations in which it is necessary to resolve the symptom of mucosal prolapse or haemorrhoidal bleeding, commonly referred to as hemorrhoids. 

But often it is not yet time to resort to traditional surgery: a good system that allows the elimination of excess tissue consists of the treatment by means of elastic ligatures.  

In a large number of cases, we are faced with an intermediate picture, in which medical therapy is no longer sufficient to keep the symptoms at bay, or it does so for a limited period of time. 

The most frequent situation is that in which bleeding on defecation recurs when medical treatment is suspended, both as hematochezia (traces of blood on the paper after defecation), and as real rectorrhagia (bleeding, even abundant, such as to stain the cup ). 

Furthermore, in some cases, the prolapse manifests itself with the continuous loss of secretion at the anal level, with consequent maceration of the perianal skin, which becomes fragile and irritated, with persistent itching and a sensation of "wet anus".  

These situations frequently correspond to the anatomical picture of a mucosal-haemorrhoidal prolapse of II-III degree: the haemorrhoidal tissue, therefore, tends to prolapse upon defecation, returning spontaneously or sometimes requiring manual repositioning by the patient. 

Frightened by the possibility of having to resort to surgery, this situation - sometimes very annoying but almost always not painful - is endured for a long time by the patient, who often resorts to any conservative attempt before turning to a specialist. 

Especially in the case of chronic itching, which very often is due to an occult mucous prolapse, the patient tends to present himself to the visit after months or years of symptoms, with a picture of chronic dermatitis, already treated locally several times with scarce and transient answer.  

How does the elastic ligation of hemorrhoids happen? 

During a normal visit, with the help of a particular anoscope, the hemorrhoidal node to be treated is tied to the base by a special elastic which causes it to be strangled and, in a few days, necrosis and detachment. The elastic is eliminated together with the removed tissue, without the patient noticing (If you are careful, it can be found in the stool upon evacuation). Healing of the mucosa then occurs with the formation of a small scar, which causes a slight localized "lifting" of the residual mucous-haemorrhoidal tissue, retracting it and bringing it back into the anal canal. 

The scar also fixes the superficial tissue to the deep planes, limiting further sliding outwards. The best indication consists precisely in the haemorrhoidal prolapse of II - III ° and in the mucous prolapse, one of the most frequent causes of difficulty in initiating defecation, often involved in the Obstructed Defecation Syndrome.


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Hemorrhoids: Eastic ligation. An alternative from the surgeon
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