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.
What are Haemorrhoids?
Haemorrhoids are commonly known as piles is a common finding in majority of the population. They can be described as masses or clumps (cushions) of supporting tissue within the anal canal.
The terminal part of the large intestine is divided into the rectum, anal canal and the anus. The anus is the external opening of the gastrointestinal tract. The waste products of digestion are passed out of the body through the anus during defecation. This clump of supporting tissue has a large number of blood vessels within it. When these veins get dilated and engorged with blood, they descend downwards pulling with themselves the supporting tissue as well (haemorrhoids). As a result the nerve endings in the anal canal get stretched causing severe pain. The number of nerve endings is more in the terminal part of the anal canal towards the anus as compared to the rectum or the upper part of the anal canal. As a result the haemorrhoids near the anus are more painful (external haemorrhoids) as compared to the haemorrhoids near the rectum (internal haemorrhoids).
What are the Symptoms of Haemorrhoids?
- Iching around the anal region.
- Pain in the anal region during sitting.
- Low risk of infection
- Short hospital stay
- Bright red streaks of blood in the stools.
- Pain during bowel movement or tender lumps near the anus.
Conventional Treatment for Haemorrhoids
The treatment of piles depends on the severity of the symptoms presented by the patient. In cases where the symptoms are mild, the patient is advised rest, suppositories and fibre rich diet and stool softeners to avoid constipation. The patients are also prescribed local application of corticosteroid and lidocaine creams to reduce pain and swelling. Sitting in a tub with warm water (Sitz bath) also provides relief in such cases.
If the above conservative measures fail to alleviate the pain, then the following surgical measures are considered:
Surgical haemorrhoidectomy involves ligation of the base of the haemorrhoids and cutting of the internal haemorrhoids. The blood supply to the external haemorrhoids also gets cut during this procedure. Eventually they shrink and fall off or they are cut. The patient is kept under observation for a night and discharged the next day. The postoperative recovery takes 2 weeks as the procedure may cause wounds near the anus which are very painful for the patient. These wounds take time to heal.
Rubber band ligation is a similar procedure. It can be done when the number of haemorrhoids is less. The procedure is done under local anaesthesia. The surgeon inserts an instrument called anoscope into the anal canal. The instrument winds a rubber band at the base of the haemorrhoid. The blood supply to the haemorrhoid is cut causing it to shrink and fall off within a week's time. 1-2 haemorrhoids can be treated at a time. For more haemorrhoids, either the procedure is done under general anaesthesia or repeated as above at intervals of 4-6 weeks.
Drawbacks: Drawbacks of these procedures include severe postoperative pain and long recovery period or prolonged duration of treatment and several visits to the doctor which takes its toll on the patient. Stapled Haemorrhoidectomy overcomes all these drawbacks. Over 2 lakh surgeries have performed worldwide with excellent outcomes. It has now become the preferred choice of treatment for both surgeons and patients in cases of third and fourth degree hemorrhoids. It avoids perianal wounds and thus reduces postoperative pain and recovery period.
Stapled Haemorrhoidectomy
Stapled hemorrhoidectomy is surgical technique for treating hemorrhoids, and is the treatment of choice for third-degree hemorrhoids
Also known as stapled hemorrhoidopexy, this surgical procedure 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).
It is also called as Procedure for Prolapse and Hemorrhoids or Circumferential Mucosectomy or Stapled Haemorrhoidopexy
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