Stapled hemorrhoidopexy

Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, is a surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. Severe cases of hemorrhoidal prolapse will normally require surgery. Newer surgical procedures include stapled transanal rectal resection (STARR) and procedure for prolapse and hemorrhoids (PPH). Both STARR and PPH are contraindicated in persons with either enterocele or anismus. Stapled hemorrhoidectomy, also known as stapled hemorrhoidopexy, is a surgical procedure that involves the removal of abnormally enlarged hemorrhoidal tissue, followed by the repositioning of the remaining hemorrhoidal tissue back to its normal anatomic position. Severe cases of hemorrhoidal prolapse will normally require surgery. Newer surgical procedures include stapled transanal rectal resection (STARR) and procedure for prolapse and hemorrhoids (PPH). Both STARR and PPH are contraindicated in persons with either enterocele or anismus. Hemorrhoids are amongst the most common anal disorders. Patients may complain of bleeding, prolapse, personal discomfort and minor anal leakage. Where traditional non-surgical measures such as rest, suppositories and dietary advice fail to improve the condition, there is then a choice of further treatments. Opinion on the best management for patients varies considerably. While many treatments for hemorrhoids may be performed without anesthetics, the lasting effect of these conservative therapies has been questioned. Many patients treated with rubber band ligation or injection sclerotherapy require multiple treatments and there is high recurrence rate following these procedures. Conventional hemorrhoidectomy provides permanent symptomatic relief for most patients, and effectively treats any external component of the hemorrhoids. However, the wounds created by the surgery are usually associated with considerable post-operative pain which necessitates a prolonged recovery period. This can put a stress on a general practitioner’s resources, may alienate the patient and delays the patient’s return to a full, normal lifestyle and the workplace. Because of this, surgeons will generally reserve formal excision for the most severe cases of prolapse, or for patients who have failed to respond to conventional treatments. Obstructed defecation syndrome (ODS) can be caused by structural deformities in the rectum resulting in chronic constipation. A new surgical procedure, Stapled Transanal Rectal Resection (STARR), can treat ODS using minimally invasive methods. STARR is a surgical procedure that is performed through the anus, requires no external incisions, and leaves no visible scars. Using a surgical stapler, the procedure removes the excess tissue in the rectum, reducing the anatomical defects that can cause ODS. In a study of 90 patients undergoing the STARR procedure, patients were hospitalized one to three days, experienced minimal postoperative pain after the procedure, and resumed employment or normal activity in 6 to 15 days. In this study, most ODS patients experienced a significant improvement in their ODS symptoms following STARR. PPH uses a circular stapler to reduce the degree of prolapse. The procedure avoids the need for wounds in the sensitive perianal area thus reducing post-operative pain considerably, and facilitates a speedier return to normal activities. This procedure was first described by an Italian surgeon – Dr. Antonio Longo, Department of Surgery, University of Palermo – in 1993 and since then has been widely adopted through Europe. This procedure avoids the need for wounds in the sensitive perianal area and, as a result, has the advantage of significantly reducing the patient’s post operative pain. Follow-up on relief of symptoms indicate a similar success rate to that achieved by conventional haemorrhoidectomy. Since PPH was first introduced it has been the subject of numerous clinical trials and in 2003 the National Institute of Clinical Evidence (NICE) in the UK issued full guidance on the procedure stating it was safe and efficacious.