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Haemorrhoid rubber band ligation

The Pilex ligation pistol

Internal haemorrhoid ligation made easy

The concept of rubber-band ligation needs little introduction. Though the method as we know it was first described in the mid-20th century, the concept of haemorrhoid ligation is much older: as far back as the fifth century BCE, Hippocrates wrote about tying haemorrhoids with thick woolen thread and waiting for them to drop off. Even today, rubber-band ligation remains one of the most cost-effective and widely used methods of treating Grade I and II internal haemorrhoids; clinical evidence indicates that it offers better long-term success rates and requires fewer overall treatments than many of the alternative treatments intended to supplant it.

The Pilex ligator consolidates many of medical science’s most practical advances in rubber-band ligation technology. The ergonomic, one-handed ligation pistol draws the haemorrhoid into position using suction, which studies have shown causes less discomfort and haemorrhage than forceps while also allowing better visibility. The transparent slotted anoscope features an extra-wide flared opening and a convenient grip for easier manoeuvrability. Best of all, the Pilex system’s specially designed single-use cartridges come pre-loaded with four bands, ensuring accurate positioning and eliminating the time-consuming process of placing each band manually.

Advantages for patients

  • Quick procedure suitable for outpatient or day-case treatment
  • Non-surgical method: no incision means no risk of incontinence
  • Immediate return to daily activities

Advantages for practitioners

  • Ergonomic tool designed for one-handed operation
  • Suction feature with controls directly on the pistol
  • Convenient single-use cartridges pre-loaded with four bands
  • Easy-to-read band counter advances automatically
  • Extra-wide, flared anoscope provides room to manoeuvre

Treatment protocol

1. Connect the ligation pistol to the suction pump. 

2. Insert the anoscope such that the haemorrhoid to be treated is within the slot. Remove the red cap from the end of the nozzle to reveal the cartridge. Introduce the ligation pistol through the anoscope, placing the tip against the haemorrhoid.

3. Flip the ligation pistol’s on/off switch to “on” in order to activate suction. Draw the haemorrhoid into the aperture of the cartridge.

4. Press the black trigger on the ligation pistol to deploy a band around the base of the haemorrhoid. The counter on the barrel of the ligation pistol will automatically advance from “0” to “1”, reflecting that one band has been used.

5. Switch off the suction, withdraw the ligation pistol, and reposition the anoscope to visualise the next haemorrhoid.

6. To remove the cartridge, re-insert the red cap with its arrow facing the mark on the nozzle, twist in the opposite direction until the two arrows are aligned, and pull. Reset the band counter to “0” by pressing the small green button on the side of the ligation pistol.

7. To insert a new cartridge, slide it (with its red cap) onto the nozzle of the ligation pistol, aligning the arrows on the red cap and the nozzle. Twist the cap so that its arrow lines up with the mark on the nozzle, and then pull the cap to remove.

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Whereas rubber-band ligation is a well-established method of treating Grade 1 and 2 piles, conventional wisdom has long held that more advanced cases require surgical intervention. We humbly beg to differ: the innovative Rafaelo® procedure represents a safe and effective non-surgical method of eliminating Grade 2, Grade 3 and early Grade 4 internal haemorrhoids via radiofrequency ablation.