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Consent Hemorrhoid Ligation - Nw Gastroenterology

Consent Hemorrhoid Ligation - Nw Gastroenterology 2026

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The document is an informed consent form for hemorrhoid ligation, a procedure that involves placing a rubber band around an internal hemorrhoid to cut off its blood supply, leading to its shrinkage and eventual detachment. It outlines the procedure's explanation, potential risks and complications, alternatives to the treatment, and includes a section for patient authorization and signature.

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Click ‘Get Form’ to open the Consent Hemorrhoid Ligation document in our editor.
Begin by reviewing the 'Explanation of Procedure' section. This provides essential information about how the hemorrhoid ligation is performed and what to expect.
Next, carefully read through the 'Principle Risks and Complications' section. It’s important to understand potential risks associated with the procedure before proceeding.
In the 'Alternatives to Hemorrhoid Ligation' section, consider other options available for managing internal hemorrhoids. This will help you make an informed decision.
Proceed to fill in your name or that of your legally authorized representative in the designated area, ensuring accuracy.
Sign in the provided space to authorize Dr. James A. Schoenecker, Jr. for the procedure, confirming your understanding of its nature and risks.
Finally, complete any additional fields such as date and time before saving or exporting your completed form.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can a nurse practitioner band a hemorrhoid?

These procedures are intended to describe procedures performed by Nurse Practitioners and/or Certified Nurse Midwives (depending on the clinical privileges granted to the individual practitioner) at UC San Diego Health. Rubber band ligation is the treatment of choice for bleeding internal hemorrhoids.

Who can perform hemorrhoid banding?

During the procedure, your gastroenterologist places a small rubber band around the hemorrhoidal tissue. The CRH ORegan system reduces unnecessary discomfort during the procedure by using a gentle suction device to grasp the tissue instead of the traditional metal-toothed clamp.

Do gastroenterologists do hemorrhoid banding?

During the procedure, your gastroenterologist places a small rubber band around the base of the hemorrhoid. This cuts off the blood supply, causing the hemorrhoid to shrink and eventually fall off within a few days. The procedure is performed in-office and typically takes less than 10 minutes.

Is hemorrhoid ligation considered surgery?

Massive bleeding, thrombosed hemorrhoids, severe pain, urinary retention needing catheterization, pelvic sepsis, fistula and death are major complications that have been less commonly reported. Several studies described different rates of complications following RBL, ranging from 3%[12] to 18.8%[13].

Who can perform hemorrhoid ligation?

A gastroenterologist is most qualified to perform a hemorrhoid ligation, as hemorrhoids are a gastrointestinal issue. A hemorrhoid ligation typically does not require anesthesia and is an in-office procedure that can be carried out with just a topical anesthetic.

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What kind of doctor performs a hemorrhoidectomy?

A general surgeon, a colon and surgeon, or proctologist will perform your hemorrhoid removal surgery in a hospital or outpatient surgery center. You will have a nerve block or general anesthesia. Most people go home the day of surgery but you may have to stay in the hospital for one night.

Consent Hemorrhoid Ligation - Nw Gastroenterology 2026

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