This is an office procedure generally reserved for grade 1 or 2 hemorrhoids with minimal symptoms. The anatomy of internal and external hemorrhoids is shown in Figure 1.
Fleets enema. No anesthetic is necessary.
The patient is usually placed in a standard kneeling position on a Ritter table, although this may also be done in the left lateral position.
The hemorrhoidal bander is prepared with two rubber bands loaded. After digital examination, a Hirschman anoscope is inserted in the anal canal, the obturator removed, and the internal hemorrhoids are evaluated. After evaluation, which includes inspection of the internal hemorrhoids in their cardinal positions (right anterior, right posterior, and lateral), a decision is made as to which hemorrhoid is the most suitable for banding. This is usually the largest hemorrhoid. The Hirschman anoscope is positioned over the target hemorrhoid to allow prolapsed into the anoscope. Care must be taken to ensure that the site of the banding is above the dentate line. An Allis clamp is first placed through the Hirschman anoscope to test the area (Figure 2A). The hemorrhoid in question is grabbed with the Allis clamp. If the ...