Anopexia – stapled hemorrhoidectomy

I wish to find out how many of you have heard of stapled hemorrhoidectomy, or have done it yourself.  A short introduction follows.

Around 1990 and the years after several people independently tried to staple-remove hemorrhoids.  There were a few publications which showed it possible.

  • 1. Linear stapler TLC or GIA.
  • 2. Linear stapler TL or similar.
  • 3. Circular stapler ILS, CEEA.

While linear staplers have been used in several places it does not provide a pain-free hemorrhoidectomy as expected from a totally closed operation. It seems that postop pain is not a function of closed or open hemorrhoidectomy.

Dr. Longo from Palermo, Italy,  devised a procedure with the circular stapler.  From the beginning it focused excision of the pile but quite soon the site of the “anastomosis” was moved up to a position well above the hemorrhoids which are not excised but reduced (lifted) and collapsed.  We may talk about a anopexia by which we may understand that hemooroidal disease is a herniation of the the piles and anal canal.  This is reversed by the procedure.

In short, a purse string suture is applied with circumferential bites in the mucosa only, 4-5 cm above the dentate line.  A 33mm circular stapler (Ethicon ILS) is introduced wide open, the purse string tied, the stapler closed and fired.  A mucosal resection and anastomosis is produced 2-3 cm above the dentate line which is virtually painfree at that height.  The operation is simple but don’t do it unless properly instructed.

Those who wish to reply a simple yes or no about personal experience, please reply to me personally.   If  you have comments of a more general interest, bring it.

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