Hemorrhoids are swollen blood vessels in the lower rectum or anus, often causing discomfort, bleeding, and sometimes prolapse. They are classified into internal and external hemorrhoids based on their location. While some hemorrhoids resolve on their own or with conservative treatments, more severe cases require surgical intervention.
Traditionally, hemorrhoid surgery involved the complete removal of hemorrhoidal tissue through a procedure known as a hemorrhoidectomy, which, although effective, often results in significant pain and a lengthy recovery period. In recent years, however, the advent of minimally invasive procedures, such as stapled hemorrhoidopexy, has provided an alternative that is less painful and allows for quicker recovery.
A circular stapler is a specialized surgical device designed to excise and staple tissue in circular patterns, primarily used in gastrointestinal and anorectal surgeries. The device places a ring of staples around the tissue, ensuring secure closure or anastomosis (reconnection of tissues) with precision.
In hemorrhoid surgery, circular staplers are used in the procedure known as stapled hemorrhoidopexy (also referred to as Procedure for Prolapse and Hemorrhoids, or PPH). The stapler excises the prolapsed hemorrhoidal tissue and simultaneously staples the remaining tissue back into place, reducing prolapse without removing hemorrhoidal tissue itself. This method is particularly effective for treating prolapsed internal hemorrhoids.
Stapled hemorrhoidopexy (PPH) is a minimally invasive surgical technique developed to treat prolapsed hemorrhoids. Unlike traditional hemorrhoidectomy, which removes the entire hemorrhoidal tissue, stapled hemorrhoidopexy uses a circular stapler to lift and secure the hemorrhoids back into their normal anatomical position without cutting them away.
This procedure is less painful and offers faster recovery compared to traditional surgery because it avoids the highly sensitive areas of the anal canal, which are rich in nerve endings. This makes stapler surgery an appealing option for patients with large, prolapsed internal hemorrhoids (grades III and IV).
The circular stapler used in hemorrhoid surgery functions by:
Repositioning Prolapsed Tissue: The surgeon inserts the stapler into the rectum, aligning it with the prolapsed hemorrhoidal tissue.
Tissue Excision and Stapling: Once positioned, the device excises a ring of the prolapsed tissue and simultaneously staples the remaining tissue in place.
Re-establishing Normal Blood Flow: By excising the prolapsed tissue, the blood supply to the hemorrhoidal vessels is reduced, which helps in shrinking the hemorrhoids over time.
The procedure typically takes less than 30 minutes and is often performed under general or regional anesthesia. Patients usually experience minimal postoperative pain due to the minimal disruption of sensitive tissues in the anal region.
Stapled hemorrhoidopexy offers several advantages over traditional hemorrhoidectomy:
Reduced Postoperative Pain: The primary benefit of stapled hemorrhoidopexy is that it avoids cutting sensitive tissues, resulting in significantly less pain compared to a traditional hemorrhoidectomy.
Faster Recovery: Most patients can resume normal activities within a few days, compared to several weeks of recovery following a hemorrhoidectomy.
Less Bleeding and Complications: The stapler's precision reduces blood loss and lowers the risk of infection or other complications.
Effective for Prolapsed Hemorrhoids: The procedure is highly effective for treating internal hemorrhoids that have prolapsed, providing long-lasting relief.
While stapled hemorrhoidopexy is generally considered safe, there are potential risks and complications, including:
Bleeding: Minor bleeding is common, but excessive bleeding can occur in rare cases.
Staple Line Complications: Issues such as staple line leaks or improper healing can lead to infection or discomfort.
Recurrence: While the procedure is effective, there is a small risk of hemorrhoid recurrence, particularly if lifestyle factors contributing to hemorrhoid development are not addressed.
Rectal Pain or Pressure: Some patients report a sensation of pressure or fullness in the rectal area after surgery.
Surgeons take several steps to minimize these risks, including careful patient selection and precise surgical technique.
The key instrument in stapled hemorrhoidopexy is the circular stapler. It consists of:
An anvil: Positioned inside the rectum, it helps guide the stapler’s operation.
Staple housing: Contains the staples and cutter, enabling simultaneous tissue excision and stapling.
Actuator handle: Allows the surgeon to control the device’s stapling and cutting functions.
Other supporting tools, such as retractors, are used to help position the stapler correctly.
In recent years, advances in stapler technology have improved the precision and safety of hemorrhoid surgeries:
Improved ergonomics: Modern staplers are designed to offer better control and maneuverability.
Single-use devices: Many staplers are now designed for single-use, minimizing the risk of contamination.
Robotic-assisted surgery: Some facilities are exploring the use of robotic systems to further improve precision in stapled hemorrhoidopexy.
Patients typically recover quickly after stapled hemorrhoidopexy. Most can return to work and normal activities within 3–7 days. Key aspects of recovery include:
Pain management: While less painful than traditional surgery, mild discomfort is common, and patients may need pain medication.
Diet: A high-fiber diet is recommended to prevent constipation and straining during bowel movements.
Wound care: Proper hygiene and wound care are crucial to avoid infection.
Stapled hemorrhoidopexy is highly effective in treating prolapsed hemorrhoids, with many patients experiencing long-term relief from symptoms such as bleeding, pain, and prolapse. Recurrence rates are low, but patients should maintain a healthy diet and lifestyle to minimize the risk of new hemorrhoid development.
Stapled hemorrhoidopexy is just one of many treatments available for hemorrhoids. Compared to other options:
Rubber band ligation: Less invasive but often requires multiple treatments for severe hemorrhoids.
Infrared coagulation: Minimally invasive but less effective for large, prolapsed hemorrhoids.
Laser hemorrhoidectomy: Another less painful option but may not be as effective for severe prolapse as stapled hemorrhoidopexy.
The cost of stapled hemorrhoidopexy varies based on factors such as:
Geographic location: Prices differ between countries and regions.
Surgical fees: Surgeons with specialized training in this procedure may charge higher fees.
Hospital charges: Costs include anesthesia, operating room fees, and postoperative care.
Stapler cost: The stapler itself is a significant cost, ranging from $200 to $800, depending on the brand and type.
On average, hemorrhoid stapler surgery costs between $2,000 and $6,000 in total, depending on the above factors.
Candidates for stapled hemorrhoidopexy typically include patients with:
Grade III or IV prolapsed internal hemorrhoids.
Those seeking a less painful alternative to traditional hemorrhoidectomy.
However, the procedure may not be suitable for patients with external hemorrhoids or those with extensive hemorrhoidal disease, where a more invasive approach might be necessary.
How effective is hemorrhoid stapler surgery in the long term?
Stapled hemorrhoidopexy is highly effective for long-term relief, with a low recurrence rate for prolapsed hemorrhoids.
What is the recovery time after stapled hemorrhoidopexy?
Most patients recover within 3 to 7 days, with minimal postoperative pain compared to traditional surgery.
Are there any risks of recurrence with stapler surgery for hemorrhoids?
There is a small risk of recurrence, especially if lifestyle factors like diet and bowel habits aren’t addressed.
How much does hemorrhoid stapler surgery cost?
The cost ranges from $2,000 to $6,000, depending on location, hospital, and the specific equipment used.
Is stapler surgery more painful than traditional hemorrhoid surgery?
No, it is generally much less painful due to the minimally invasive nature of the procedure.
How do I know if I’m a good candidate for stapler hemorrhoid surgery?
Your doctor will assess the severity and type of hemorrhoids to determine if stapled hemorrhoidopexy is the right option.
Stapled hemorrhoidopexy using a circular stapler offers a minimally invasive alternative to traditional hemorrhoid surgery. With benefits like reduced pain, faster recovery, and long-term symptom relief, it is becoming a preferred treatment for prolapsed internal hemorrhoids. However, as with any surgery, careful patient selection and understanding of the potential risks and benefits are essential for successful outcomes.