Stapled Hemorrhoidectomy

Medical Author: Jay W. Marks, MD
Medical Editor: Thomas P. Sokol, MD, FACS, FASCRS

Stapled hemorrhoidectomy is the newest surgical technique for treating hemorrhoids. Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward.

For stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal canal. Through this tube, a suture (a long thread) is placed, actually woven, circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler (a disposable instrument with a circular stapling device at the end) is placed through the first hollow tube and the ends of the suture are pulled. Pulling the suture pulls the expanded hemorrhoidal supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue.

Internal Hemorrhoids in Anal Canal

Hollow Tube Inserted into the Anal Canal and Pushing up the Hemorrhoids

Suturing the Anal Canal through the Hollow Tube

Bringing Expanded Hemorrhoidal Supporting Tissue into the Hollow Tube by Pulling on Suture

Hemorrhoids Pulled Back Above Anal Canal after Stapling and Removal of Hemorrhoidal Supporting Tissue

During stapled hemorrhoidectomy, the arterial blood vessels that travel within the expanded hemorrhoidal tissue and feed the hemorrhoidal vessels are cut, thereby reducing the blood flow to the hemorrhoidal vessels and reducing the size of the hemorrhoids. During the healing of the cut tissues around the staples, scar tissue forms, and this scar tissue anchors the hemorrhoidal cushions in their normal position higher in the anal canal. The staples are needed only until the tissue heals. They then fall off and pass in the stool unnoticed after several weeks. Stapled hemorrhoidectomy is designed primarily to treat internal hemorrhoids, but if external hemorrhoids are present, they may be reduced as well.

Stapled hemorrhoidectomy is faster than traditional hemorrhoidectomy, taking approximately 30 minutes. It is associated with much less pain than traditional hemorrhoidectomy and patients usually return earlier to work. Patients often sense a fullness or pressure within the rectum as if they need to defecate, but this usually resolves within several days. The risks of stapled hemorrhoidectomy include bleeding, infection, anal fissuring (tearing of the lining of the anal canal), narrowing of the anal or rectal wall due to scarring, persistence of internal or external hemorrhoids, and, rarely, trauma to the rectal wall.

Stapled hemorrhoidectomy was first used in Europe in the mid 1990's and there has been increasing, worldwide usage in recent years. If results continue to be good with more experience and longer follow-up of patients, stapled hemorrhoidectomy is likely to become the mainstay of surgical therapy for symptomatic, prolapsing hemorrhoids.

From the Doctors at MedicineNet.com

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