From the Guidelines
Hemorrhoidal (arterial) fistula banding is indicated for second- and third-degree hemorrhoids, particularly when medical treatment has failed, and for patients with symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids. The primary indications for hemorrhoidal (arterial) fistula banding include:
- Second- and third-degree hemorrhoids that are unresponsive to medical treatment
- Symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids
- Failure of nonoperative management, such as sclerotherapy or infrared photocoagulation
- Patient preference, after discussion of treatment options with the referring physician and surgeon The procedure involves placing a constricting band around the hemorrhoidal tissue, which can be performed in an outpatient setting without the need for anesthesia 1. Some key points to consider when evaluating the indications for hemorrhoidal (arterial) fistula banding include:
- The effectiveness of nonoperative techniques, such as rubber band ligation, which has been shown to have a lower recurrence rate compared to sclerotherapy 1
- The potential complications of surgical hemorrhoidectomy, including urinary retention, bleeding, anal stenosis, infection, and incontinence 1
- The importance of patient preference and discussion of treatment options with the referring physician and surgeon 1 It is essential to note that the evidence for hemorrhoidal (arterial) fistula banding is based on studies from 2004, and more recent studies may have updated recommendations 1. However, based on the available evidence, hemorrhoidal (arterial) fistula banding is a viable treatment option for patients with second- and third-degree hemorrhoids, particularly when medical treatment has failed, and for patients with symptomatic third-degree, fourth-degree, or mixed internal and external hemorrhoids.
From the Research
Indications for Hemorrhoidal (Arterial) Fistula Banding
The provided studies do not directly address the indications for hemorrhoidal (arterial) fistula banding. However, they do discuss the treatment of symptomatic hemorrhoids using rubber band ligation (RBL) and Doppler-guided hemorrhoidal artery ligation (DG-HAL).
Treatment of Symptomatic Hemorrhoids
- Rubber band ligation (RBL) is a safe and effective treatment for symptomatic internal hemorrhoids, including grade 2 and 3 hemorrhoids 2, 3, 4, 5.
- RBL can be used to treat all degrees of hemorrhoids with similar effectiveness 4.
- Doppler-guided hemorrhoidal artery ligation (DG-HAL) is also a safe and effective treatment for symptomatic grade 2 and 3 hemorrhoids 6.
- The success rate of RBL is high, with 70.5% to 89% of patients experiencing symptom relief 3, 4, 5.
- Complications of RBL are relatively rare, but can include bleeding, thrombosed external hemorrhoids, and bacteremia 2, 4, 5.
Limitations of the Studies
- The studies do not provide direct evidence for the indications of hemorrhoidal (arterial) fistula banding.
- The studies primarily focus on the treatment of symptomatic hemorrhoids using RBL and DG-HAL, rather than the treatment of hemorrhoidal (arterial) fistulas.