Stapled hemorrhoidopexy - general and visceral surgery

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date of publication: 24.09.2009

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  • Verifying the indication and dilating the anal sphincter


    Check, whether the hemorrhoids can be reduced, and if so, intraoperatively verify the indication for stapled hemorrhoidopexy. Carefully dilate the anal sphincter.

  • Purse string suture

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    With the PPH set (Procedure for Prolapse and Hemorrhoids), place a circular, submucous purse string suture just superior to the hemorrhoidal base, markedly proximal to the dentate line and sparing the muscles.

  • Inserting the stapler

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    With the stapler fully opened, close and tie the purse string suture below the anvil. Digitally examine the anal canal and stapler position.

  • Resecting the hemorrhoidal tissue

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    When the stapler is being closed, it is pulled 3-4 cm into the anal canal, thereby ensuring that the distal part of the cartridge is safely positioned proximal to the dentate line. The hyperplastic hemorrhoidal tissue is resected by triggering the stapler. Open the stapler just a few millimeters and gently remove the device. Inspect the resectate. In 50-60% of cases there will be tangentially transected fibers of the muscularis propria on the extraluminal aspect of the resectate.

  • Terminating the procedure

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    Digitally examine the suture line for potential broader wound dehiscence. Visually inspect the suture line for bleeding. Usually hemostasis only requires a few suture ligations. Packing the anal canal with a tamponade (e.g. anal tampon) is optional.