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Stapled Haemorrhoidectomy
It is also called as Procedure for Prolapse and Hemorrhoids or Circumferential Mucosectomy or Stapled Haemorrhoidopexy.

The procedure involves removal of the loose connective tissue and repositioning of the hemorrhoids within the anal canal. It is the procedure of choice in 3rd and 4th degree prolapse or minor hemorrhoids that have not cured by conventional methods. The procedure can be combined with conventional haemorrhoidectomy in few cases if required. The procedure is contraindicated in severe fibrotic piles in which physical repositioning is not possible. Also in enterocele and anismus, the procedure is not advised.

It is a short surgery of 30 minutes and can be performed under local anaesthesia with sedation or spinal or epidural anaesthesia. In few cases general anaesthesia may be required. The patient is made to lie on his stomach on the operation table or in the lithotomy position. No special preoperative preparation is required.

The patient does not consume anything after the midnight before surgery. Enema is given at night and before the surgery. The use of antibiotics is generally not required.

After the patient has been positioned and sedated, the anal opening is gently massaged and the obturator is inserted to dilate the canal. This prevents injury to the internal sphincter. The obturator is removed and reinserted along with the circular hollow tube called the dilator. This pushes the loose supporting tissue higher inside.

The base of the dilator has 4 slits through which it is anchored to the perianal skin with the help of 3-4 sutures. The stapler cuts off the circumferential ring of expanded supporting tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue. We now have a tightened supporting tissue which holds the haemorrhoids in place.

During the healing of the cut tissues around the staples, scar tissue forms, and this scar tissue anchors the haemorrhoidal 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 haemorrhoidectomy is designed primarily to treat internal haemorrhoids, but if external haemorrhoids are present, they can be reduced as well.

Since the postoperative pain and discomfort is less the patient is usually discharged on the same day or the next day. Patients can resume their normal activities within a week's time.

The procedure has very few complications. They include post PPH syndrome (inflammation of internal sphincters for which anti-inflammatory medications are given), bowel discomfort, slight bleeding, 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 haemorrhoids, and, rarely, trauma to the rectal wall. These complications occur only in very few cases.
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Yes, i am also told the same. the tiny titanium ring will remain for rest of life.I am surprised many who have done stapled are saying that these staples fall of after several weeks. is there different type of staples used? not sure
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thanks for the input. I just had the procedure and I am having issues getting the flow started and then it is just a trickle. I'll thy the bottle technique.
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