Stapled Hemorrhoidectomy
Medical Author: Jay W. Marks, MD
Medical Editor: Thomas P. Sokol, MD, FACS, FASCRS
What are hemorrhoids?
A precise definition of hemorrhoids does not exist, but they
can be described as masses or clumps ("cushions") of tissue within the anal
canal that contain blood vessels and the surrounding, supporting tissue made
up of muscle and elastic
fibers. The anal canal is the last four centimeters through which stool passes
as it goes from the rectum to the outside world. The anus is the opening of the
anal canal to the outside world.
Although most people think hemorrhoids are abnormal, they
are present in everyone. It is only when the hemorrhoidal cushions enlarge that
hemorrhoids can cause problems and be considered abnormal or a disease.
Prevalence of hemorrhoids
Although hemorrhoids occur in everyone, they become large and cause problems in
only 4% of the general population. Hemorrhoids that cause problems are
found equally in men and women, and their prevalence peaks between 45 and 65
years of age.
What is stapled hemorrhoidectomy?
Stapled hemorrhoidectomy is the newest surgical technique for treating
hemorrhoids, and it has rapidly become the treatment of choice for third-degree
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.
Who is a candidate for stapled hemorrhoidectomy?
Stapled hemorrhoidectomy, although it can be used to treat second degree hemorrhoids, usually is reserved for higher grades of hemorrhoids - third and fourth degree. If in addition to internal hemorrhoids there are small external hemorrhoids that are causing a problem, the external hemorrhoids may become less problematic after the stapled hemorrhoidectomy. Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids.
Next: Pictures of stapled hemorrhoidectomy procedure »
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