Historical Background: Treatments for Hemorrhoids and ODS Prior to Transanal Stapling Techniques

Over the past decade several innovations in surgical technology have tried to address the painful anodermal wounds and protracted recovery associated with conventional excisional hemorrhoidecto-my. Of these, only the stapled hemorrhoidopexy has achieved recognition as a viable alternative. However, the introduction of stapled hemorrhoidopexy into routine clinical practice was not without controversy. In this chapter, we describe the rationale underlying the technique and discuss the historical background to its eventual acceptance. In addition, we present the evolution of a novel technique, stapled transanal rectal resection (STARR) for the treatment of obstructed defecation syndrome (ODS). This was inspired by the success of stapled hemorrhoidopexy together with the observation that symptoms of rectal outlet obstruction could be improved by resection of the redundant distal rectum. The concept of internal rectal prolapse as the primary etiology underlying ODS is presented.