Instrument for the ligation of hemorrhoids or the like

The instrument for the ligation of hemorrhoids or the like includes a substantially cylindrical container with a coupling for the connection of an air aspiration apparatus and a grip handle for the operator. The container is suitable for internally accommodating a hemorrhoid or the like aspirated through its open end, on which a dilated ring-like elastic ligature, to be transferred so as to throttle the "neck" of the hemorrhoid or the like, is arrangeable externally and circumferentially. The instrument is characterized in that the container is provided with a thumb-actuated hole for adjusting the pressure inside it while the aspiration apparatus is operating.

BACKGROUND OF THE INVENTION 
The present invention relates to an instrument for the ligation of 
hemorrhoids or the like. 
Various methods for the therapy of hemorrhoids are currently used when said 
hemorrhoids no longer respond to strictly medical cures or when their size 
becomes such that any non-surgical therapy would produce no result or even 
negative results. 
A first method is the strictly surgical one, which is irreplaceable in case 
of considerable internal and external prolapses. 
This is a painful method which entails significant postoperative 
hospitalization and is also usually rather destructive as regards the 
muscles of the anal-proctorectal tract. 
A second method is constituted by cryosurgery, which in practice consists 
in "freezing" the hemorrhoids at temperatures which can vary between -59 
degrees Celsius and -89 degrees Celsius for cycles lasting a few minutes. 
Another method is constituted by thermosurgery, which uses devices which 
emit flows of heat at preset temperatures and for limited periods of time. 
A method which is currently having considerable success, since it is the 
easiest, quickest and most practical, as well as the least painful and 
least damaging, is the so-called "throttling" surgery. 
This method consists in applying an elastic ring of adequate size on the 
"neck" of the hemorrhoid, leaving it in place until the hemorrhoid 
necrotizes and falls away spontaneously due to the occlusion of the blood 
supply pathways. 
The time required in order to achieve this effect is relatively short, the 
results are extremely positive and the method, which is typically 
ambulatory, is not painful. 
A cylindrical bush is used to apply the ligature to the "neck" of the 
hemorrhoid, and the elastic ring is arranged around said bush, dilating 
the ring considerably, by means of a conical applicator. 
Once the hemorrhoid has been passed through said bush, the elastic ring is 
caused to slide, moving it so that it surrounds the "neck" of the 
hemorrhoid and, by pressing on it, performs the throttling action. 
Two methods are currently used to make the hemorrhoids pass in the bush. 
A first one of said methods consists in making a special instrument pass 
through the bush; said instrument is provided with a forceps at its end, 
which is suitable for gripping a portion of the hemorrhoid and for pulling 
it inside the bush. 
This method has a series of problems, some of which are considerable; first 
of all, the need arises to use both hands, one for the bush and one for 
the instrument provided with the forceps. 
It is furthermore rather traumatic, since the forceps can break the wall of 
the hemorrhoid. 
Furthermore, it is not always possible to achieve the passage of the entire 
mass to be throttled. 
In a second method, which is pneumatic, the bush constitutes the end of a 
duct which is connected to an aspirator which, when actuated, aspirates 
the hemorrhoid inside said bush. 
Although this method has the advantage that it does not break the wall of 
the hemorrhoid and can be performed with one hand, it has the problem that 
during the operation the bush is constantly at negative pressure, so that 
the hemorrhoid cannot be disengaged in case of incorrect grip; 
furthermore, at the end of the operation it is necessary to disconnect the 
aspiration system from the instrument in order to be able to disengage the 
hemorrhoid. 
For both "throttling" methods, the typically metallic material of which the 
instruments are made must be resterilized after each use and, since such 
materials are not transparent, it forces the operator to work practically 
blind. 
The instruments themselves are furthermore considerably expensive. 
SUMMARY OF THE INVENTION 
The aim of the present invention is to provide a new instrument for 
applying the method for curing hemorrhoids or the like by "throttling" 
which solves or at least reduces the problems described above in the known 
art. 
Within the scope of the above aim, a consequent primary object is to 
provide an instrument which allows to disengage a hemorrhoid or the like 
in case of incorrect grip and to engage it again rapidly and without 
problems. 
Another important object is to provide an instrument which is suitable even 
for considerable hemorrhoidal volumes. 
Another important object is to provide an instrument by means of which 
operations can be monitored visually. 
Yet another object is to provide a disposable instrument which can thus be 
supplied in pre-sterilized form so as to prevent cross-infections and 
contagions. 
Still another object is to provide an instrument characterized by extreme 
ease of use. 
Yet another object is to provide an instrument which can be manufactured in 
large series and at low cost, so that it can be marketed at an extremely 
competitive price. 
This aim, these objects and others which will become apparent hereinafter 
are achieved by an instrument for the ligation of hemorrhoids or the like, 
which comprises a substantially cylindrical container with a coupling for 
connection to an air aspiration apparatus and a grip handle for the 
operator, said container being suitable for internally accommodating a 
hemorrhoid or the like aspirated through its open end, on which a dilated 
ring-like elastic ligature, to be transferred so as to throttle the "neck" 
of the hemorrhoid or the like, is arranged circumferentially and 
externally, said instrument being characterized in that said container is 
provided with means suitable for adjusting the pressure inside it while 
the aspiration apparatus is operating.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
With reference to the above figures, the instrument for the ligation of 
hemorrhoids or the like, completely made of transparent or partially 
transparent plastic material, for example by injection-molding, comprises 
an elongated cylindrical container 1 having an internal passage; a 
coupling duct 2 for connection to an air aspiration apparatus, not 
illustrated, ends at a region which is adjacent to the bottom of said 
container and is in communication with the passage thereof. 
Said coupling 2 extends externally, in a first handle portion 3, which 
gives the assembly the appearance of a sort of pistol, in which a user's 
palm can be wrapped around the handle position. 
In a second terminal portion, said coupling 2 is provided with external 
annular ridges 4 for the coupling of the hose for connection to said 
aspiration apparatus. 
Said container 1 is suitable for accommodating, inside its open end 5, a 
hemorrhoid or the like aspirated by the previously mentioned apparatus. 
A ring-shaped elastic ligature 7 is conveniently arranged circumferentially 
on the outside of said end 5, by means of a funnel-shaped conical 
applicator 6 which is provided with a tang 6a which removably couples to 
said end 5. 
As can be seen in the figures, said ligature 7 is extremely dilated with 
respect to its inactive condition when it is arranged on the end 5. 
According to the invention, the bottom of said container 1 is provided with 
a hole 8 which allows manual adjustment of the pressure inside the 
container 1. 
In practice, said hole 8 is arranged so that it can be very easily closed 
by the thumb of the hand that grips the instrument, so that while the 
aspiration apparatus is operating, negative-pressure or 
atmospheric-pressure conditions are obtainable inside said container 1. 
A tubular pusher element 9 is slidingly externally coupled to said 
container 1 and extends between the region of the end 5 on which the 
ligature 7 is arranged and the coupling region of said handle 3, where a 
first-class lever element 10 is articulated to the instrument and is 
suitable for pushing the tubular pusher element 9 so that it disengages 
the ligature 7 from the end 5. 
As can be seen from the figures, the lever element 10 is substantially 
shaped like a trigger, with articulation pivots 11 arranged laterally to 
the handle 3 and two fork-like wings 12 arranged between the edge of the 
element and corresponding stop pins 13 which are lateral to the bottom of 
the container 1. 
Conveniently, said pusher element 9 is provided with an internal annular 
ridge 14 which is accommodated in a corresponding external annular groove 
15 defined externally on the container 1. 
This is provided in order to limit the sliding movements of the tubular 
element 9 to the extent strictly necessary. 
The ridge 14 in any case has such a height as to allow it to pass beyond 
the obstacle constituted by the end 5 by deforming elastically when the 
element 9 is fitted to the container 1. 
As regards the use of the instrument, after the ligature 7 has been 
positioned by means of the conical element 6 and after such conical 
element has been removed, the aspiration apparatus is started and the 
handle 3 is gripped, closing the hole 8 with the thumb. 
At this stage the end 5 can be positioned at the hemorrhoid or the like, 
which is aspirated inside the container 1. 
The operation is performed in viewing conditions, since the instrument, as 
mentioned previously, is made of transparent material. 
It is thus possible to see whether the hemorrhoid or the like has entirely 
entered the container 1 and thus press on the lever element 10 which, by 
moving the pusher element 9, transfers the ligature 7 around the "neck" of 
the hemorrhoid, throttling it. 
If the hemorrhoid has been gripped incorrectly, the aspiration effect can 
be eliminated, returning the container to atmospheric pressure, by simply 
removing the thumb of the hand from the hole 8, thus opening it. 
At this point it should be stressed that the diameter of the container 1 is 
considerable and is thus suitable for containing large hemorrhoidal 
volumes. 
Furthermore, since the instrument is made of plastic material, it is 
disposable and also has an extremely modest cost. 
The fact that the instrument can be operated with one hand and without 
having to disconnect the aspiration apparatus during the operation is also 
highly significant. 
In practice it has thus been observed that the instrument according to the 
invention has achieved the intended aim and objects of the present 
invention. 
The invention thus conceived is susceptible to numerous modifications and 
variations, all of which are within the scope of the inventive concept. 
Thus, the handle 3 and the container 1 may be non-monolithic and may be 
mutually interchangeably associated, for example with a snap-together 
coupling 
In this manner, the handle may be made of a non-disposable material, for 
example stainless steel, whereas the part which relates to the container 1 
and to the pusher element 9, made of plastic material, can be changed at 
each operation. 
Furthermore, all the details may be replaced with other technically 
equivalent elements; thus, for example, the tubular pusher element may be 
replaced with pusher elements having another shape which can in any case 
slide on the outside of the container 1. 
In practice, the materials employed, so long as compatible with the 
contingent use, as well as the dimensions, may be any according to the 
requirements.