Having discussed haemorrhoidal disease and the primary mechanisms behind its onset in our previous article, we shall now focus our attention on outpatient treatment options. These are minimally invasive solutions, effective primarily in the early stages and, in selected cases, even in more advanced forms. These therapeutic approaches are well-established and allow for a significant improvement in symptoms with a reduced impact on daily life. The choice of the most suitable method must always be personalised, based on a thorough proctological evaluation and the clinical characteristics of the individual patient.
Haemorrhoid banding
Elastic band ligation (banding) is one of the most effective and established outpatient techniques for treating internal haemorrhoidal disease. It is a minimally invasive procedure aimed at progressively reducing the volume of the haemorrhoidal cushions by interrupting their blood supply. The patient is placed in the lateral decubitus or lithotomy position. Using a cylindrical instrument called an anoscope, the specialist identifies the haemorrhoidal cushion to be treated and applies a small elastic band to its base. This causes an interruption in blood flow, resulting in the “strangulation” of the tissue, which undergoes necrosis and detaches spontaneously over the following days, before being passed with the stool.
The ligation procedure is generally well-tolerated and, in most cases, pain is absent or mild. In the hours or days following the procedure, one may experience a sensation of heaviness or slight rectal discomfort, while a minor bleed may occur when the haemorrhoidal nodule detaches (usually after 5–10 days). During this period, a diet rich in fibre and fluids is recommended to keep stools soft and facilitate evacuation. Normal daily activities can be carried out without particular limitations, though intense exertion, such as gym workouts or heavy lifting, should be avoided.
Sclerotherapy
Sclerotherapy is a minimally invasive technique that can be performed in an outpatient setting. It is particularly indicated for treating internal haemorrhoids in less advanced stages, especially when the primary symptom is bleeding. The procedure is performed, again with the aid of an anoscope, allowing the specialist to pinpoint the haemorrhoidal cushions accurately. At this point, a 3% polidocanol sclerosing foam is injected directly into the haemorrhoidal tissue: this is a medication that triggers a controlled reaction, leading over time to a reduction in blood flow and the volume of the haemorrhoids. The treatment is generally well-tolerated. Side effects, when present, are usually mild and temporary, and may include slight local discomfort or, more rarely, modest bleeding in the following days.
ScleroBanding: the combined technique
ScleroBanding is a combined outpatient technique that unites sclerotherapy and elastic band ligation, aiming to exploit the advantages of both methods. The synergetic action of these two techniques allows for simultaneous intervention on two fundamental aspects of haemorrhoidal disease: vascular congestion, thanks to the sclerosing effect, and tissue prolapse, through the mechanical ligation of the cushion. For this reason, it is particularly effective in cases where symptoms are combined, featuring both bleeding and prolapse.
The technique was first described in 2021 by Dr. Salvatore Bracchitta⁽¹⁻²⁻³⁾, who subsequently evaluated its feasibility and safety through the first clinical study. One of the most innovative aspects of the method is the ability to confine the sclerosing substance, administered in foam form, within the haemorrhoidal nodule thanks to the elastic band. This mechanism not only enhances the effectiveness of the treatment but also reduces the risk of complications. In particular, it helps decrease the incidence of delayed bleeding, which can sometimes be significant, occurring after the elastic band falls off in traditional ligation.
WEBSITE REFERENCES
- www.sclerobanding.com
- Bracchitta S, Bracchitta LM, Pata F. Combined rubber band ligation with 3% polidocanol foam sclerotherapy (ScleroBanding) for the treatment of second-degree haemorrhoidal disease: a video vignette. Colorectal Dis. 2021 Jun;23(6):1585-1586. doi: 10.1111/codi.15613. Epub 2021 Mar 22. PMID: 33660907.
- Pata F, Bracchitta LM, D’Ambrosio G, Bracchitta S. Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes. J Clin Med. 2021 Dec 31;11(1):218. doi: 10.3390/jcm11010218. PMID: 35011962; PMCID: PMC8745462.
