A precise definition of hemorrhoids does not exist, but they can be described as masses or clumps (“cushions”) of tissue within the anal canal that contain blood vessels and the surrounding, supporting tissue made up of muscle and elastic fibers.
The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world.
Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.
Prevalence of hemorrhoids
Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population.
Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.
What is stapled hemorrhoidectomy?
Stapled hemorrhoidectomy is surgical technique for treating hemorrhoids, and is the treatment of choice for third-degree hemorrhoids.
Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward.
For stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal canal. Through this tube, a suture (a long thread) is placed, actually woven, circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube.
The stapler (a disposable instrument with a circular stapling device at the end) is placed through the first hollow tube and the ends of the suture are pulled. Pulling the suture pulls the expanded hemorrhoidal supporting tissue into the jaws of the stapler.
The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue.
Who is a good candidate for stapled hemorrhoidectomy?
Stapled hemorrhoidectomy, although it can be used to treat second degree hemorrhoids (hemorrhoids that extend outside the anus with a bowel movement, but return inside), usually is reserved for higher grades of hemorrhoids – third and fourth degree.
Third degree hemorrhoids can be pushed back into the anus after a bowel movement. Fourth degree hemorrhoids are always outside. If in addition to internal hemorrhoids there are small external hemorrhoids that are causing a problem, the external hemorrhoids may become less problematic after the stapled hemorrhoidectomy.
Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids.
A hemorrhoidectomy is performed in the following settings:
- Symptomatic grade III, grade IV, or mixed internal and external hemorrhoids
- Where there are additional anorectal conditions that require surgery
- Strangulated internal hemorrhoids
- Some thrombosed external hemorrhoids
- Where patients who cannot tolerate or fail minimally invasive procedures
Types of hemorrhoidectomies and related procedures performed during surgery:
- Closed Hemorrhoidectomy
- Open Hemorrhoidectomy
- Stapled Hemorrhoidectomy (Procedure for Prolapse and Hemorrhoids – PPH)
- Rubber band Ligation
- Lateral Internal Sphincterotomy
What happens to the staples from a stapled hemorrhoidectomy?
During stapled hemorrhoidectomy, the arterial blood vessels that travel within the expanded hemorrhoidal tissue and feed the hemorrhoidal vessels are cut, thereby reducing the blood flow to the hemorrhoidal vessels and reducing the size of the hemorrhoids.
During the healing of the cut tissues around the staples, scar tissue forms, and this scar tissue anchors the hemorrhoidal cushions in their normal position higher in the anal canal. The staples are needed only until the tissue heals. After several weeks, they then fall off and pass in the stool unnoticed.
Stapled hemorrhoidectomy is designed primarily to treat internal hemorrhoids, but if external hemorrhoids are present, they may be reduced as well.
How long does stapled hemorrhoidectomy take?
Stapled hemorrhoidectomy is faster than traditional hemorrhoidectomy, taking approximately 30 minutes. It is associated with much less pain than traditional hemorrhoidectomy and patients usually return earlier to work.
Patients often sense a fullness or pressure within the rectum as if they need to defecate, but this usually resolves within several days.
The risks of stapled hemorrhoidectomy include bleeding, infection, 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 hemorrhoids, and, rarely, trauma to the rectal wall.
Stapled hemorrhoidectomy may be used to treat patients who have both internal and external hemorrhoids; however, it also is an option to combine a stapled hemorrhoidectomy to treat the internal hemorrhoids and a simple resection of the external hemorrhoids.