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.