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Reviews on Recent Clinical Trials


ISSN (Print): 1574-8871
ISSN (Online): 1876-1038

Review Article

Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times

Author(s): Alessandro Sturiale*, Bernardina Fabiani, Claudia Menconi, Danilo Cafaro, Felipe Celedon Porzio and Gabriele Naldini

Volume 16, Issue 1, 2021

Published on: 10 March, 2020

Page: [39 - 53] Pages: 15

DOI: 10.2174/1574887115666200310164519

Price: $65


Introduction: Hemorrhoidal disease is the most common proctologic condition in adults. Among the different surgical procedures, one of the greatest innovations is represented by the stapled hemorrhoidopexy. The history of this technique started with a single stapler use passing through a double stapler technique to resect the adequate amount of prolapse, finally coming to the use of high volume devices.

Methods: Nevertheless, each device has its own specific feature, the stapler is basically made up with one or more circular lines of titanium staples whose height may be variable. The procedure is based on different steps: Introduction of the CAD, evaluation of the prolapse, fashioning purse string or parachute suture, the introduction of the stapler head beyond the suture, pull the wires through the window, close the stapler and keep pulled the wires of the suture held together with forceps, fire using two hands, open the stapler and remove it and check the staple line and then check the specimen. One of the latest innovations in stapled surgery is Tissue Selective Therapy. It is a minimally invasive procedure in which there is a partial circular stapled hemorrhoidopexy focused on the prolapsing piles with bridges of normal mucosa left.

Results: Several studies have reported that SH is a safe and effective procedure to treat hemorrhoidal prolapse. It is a quicker procedure with a shorter hospital stay and earlier return to work if compared with the conventional treatment. This is due to less postoperative pain, postoperative bleeding, wound complications and constipation. Furthermore, the first generation devices had worse outcomes if compared with those of the new generation stapler that showed lower postoperative complication rates with better anatomical and symptomatic results.

Conclusion: Stapled procedure for the treatment of symptomatic hemorrhoidal prolapse represents one of the most important innovations in proctology of the last century bringing with it the new revolutionary concept of the rectal intussusception as a determining factor involved in the natural history of the disease. Stapled hemorrhoidopexy marked an era in which the surgeon may offer the patients a safe, effective treatment with less pain and fast recovery.

Keywords: Stapled Hemorrhoidopexy, hemorrhoids, hemorrhoidal prolapse, PPH, high volume hemorrhoidopexy, stapler complications.

Graphical Abstract
Abramowitz L, Benabderrahmane M, Pospait D, Philip J, Laouénan C. The prevalence of proctological symptoms amongst patients who see general practitioners in France. Eur J Gen Pract 2014; 20(4): 301-6.
[] [PMID: 24702041]
Gallo G, Sacco R, Sammarco G. Epidemiology of hemorrhoidal disease. Coloproctology 2018; 2: 3-7.
Albuquerque A. Rubber band ligation of hemorrhoids: A guide for complications. World J Gastrointest Surg 2016; 8(9): 614-20.
[] [PMID: 27721924]
Miyamoto H, Hada T, Ishiyama G, Ono Y, Watanabe H. Aluminum potassium sulfate and tannic acid sclerotherapy for Goligher Grades II and III hemorrhoids: Results from a multicenter study. World J Hepatol 2016; 8(20): 844-9.
[] [PMID: 27458504]
Lobascio P, Minafra M, Laforgia R, et al. use of sclerotherapy with polidocanol foam in the treatment of second-degree haemorrhoidal disease – a video vignette Color Dis 21:codi 2018; 14498.
Ratto C, Campennì P, Papeo F, Donisi L, Litta F, Parello A. Transanal hemorrhoidal dearterialization (THD) for hemorrhoidal disease: a single-center study on 1000 consecutive cases and a review of the literature. Tech Coloproctol 2017; 21(12): 953-62.
[] [PMID: 29170839]
Hoyuela C, Carvajal F, Juvany M, et al. HAL-RAR (Doppler guided haemorrhoid artery ligation with recto-anal repair) is a safe and effective procedure for haemorrhoids. Results of a prospective study after two-years follow-up. Int J Surg 2016; 28: 39-44.
[] [PMID: 26876958]
Giamundo P. Advantages and limits of hemorrhoidal dearterialization in the treatment of symptomatic hemorrhoids. World J Gastrointest Surg 2016; 8(1): 1-4.
[] [PMID: 26843909]
Bhatti MI, Sajid MS, Baig MK. Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials. World J Surg 2016; 40(6): 1509-19.
[] [PMID: 26813541]
Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with a circular-suturing device: A new procedure. Proceedings of the sixth world congress of endoscopic surgery. Rome, Italy. 1998.
Naldini G, Martellucci J, Moraldi L, Romano N, Rossi M. Is simple mucosal resection really possible? Considerations about histological findings after stapled hemorrhoidopexy. Int J Colorectal Dis 2009; 24(5): 537-41.
[] [PMID: 19169693]
Naldini G, Martellucci J, Talento P, Caviglia A, Moraldi L, Rossi M. New approach to large haemorrhoidal prolapse: Double stapled haemorrhoidopexy. Int J Colorectal Dis 2009; 24(12): 1383-7.
[] [PMID: 19547990]
Naldini G, Fabiani B, Menconi C, Giani I, Toniolo G, Martellucci J. Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus. Int J Colorectal Dis 2015; 30(12): 1723-8.
[] [PMID: 26208412]
Wang ZG, Zhang Y, Zeng XD, et al. Clinical observations on the treatment of prolapsing hemorrhoids with tissue selecting therapy. World J Gastroenterol 2015; 21(8): 2490-6.
[] [PMID: 25741159]
Khubchandani IT. H.-C. Lin, D.-L. Ren, Q.-L. He, H. Peng, S.-K. Xie, D. Su, X.-X. Wang: Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: A two-year prospective controlled study. Tech Coloproctol 2012; 16(5): 345.
[] [PMID: 22936580]
Lin H-C, He Q-L, Ren D-L, et al. Partial stapled hemorrhoidopexy: a minimally invasive technique for hemorrhoids. Surg Today 2012; 42(9): 868-75.
[] [PMID: 22160324]
Sturiale A, Fabiani B, Menconi C, et al. Long-term results after stapled hemorrhoidopexy: A survey study with mean follow-up of 12 years. Tech Coloproctol 2018; 22(9): 689-96.
[] [PMID: 30288629]
Naldini G, Martellucci J, Rea R, et al. Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus. Int J Colorectal Dis 2014; 29(5): 623-9.
[] [PMID: 24569943]
Gallo G, Martellucci J, Sturiale A, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): Management and treatment of hemorrhoidal disease. Tech Coloproctol 2020; 24(2): 145-64.
[] [PMID: 31993837]
Reboa G, Gipponi M, Gallo M, et al. High-Volume Transanal Surgery with CPH34 HV for the Treatment of III-IV Degree Haemorrhoids: Final short-term results of an italian multicenter clinical study. Surg Res Pract 2016; 20162906145
[] [PMID: 26998510]
Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: A systematic review. Int Surg 2015; 100(1): 44-57.
[] [PMID: 25594639]
Menconi C, Fabiani B, Giani I, Martellucci J, Toniolo G, Naldini G. Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line. Int J Colorectal Dis 2016; 31(1): 41-4.
[] [PMID: 26248794]
De Santis G, Gola P, Lancione L, Sista F, Pietroletti R, Leardi S. Sigmoid intramural hematoma and hemoperitoneum: an early severe complication after stapled hemorrhoidopexy. Tech Coloproctol 2012; 16(4): 315-7.
[] [PMID: 21678070]
Naldini G. Serious unconventional complications of surgery with stapler for haemorrhoidal prolapse and obstructed defaecation because of rectocoele and rectal intussusception. Colorectal Dis 2011; 13(3): 323-7.
[] [PMID: 20002689]
Grapsi A, Sturiale A, Fabiani B, Naldini G. Mucocele complicating stapled hemorrhoidopexy. Int J Surg Case Rep 2017; 33: 38-40.
[] [PMID: 28273604]
Pescatori M, Spyrou M, Cobellis L, Bottini C, Tessera G. The rectal pocket syndrome after stapled mucosectomy. Colorectal Dis 2006; 8(9): 808-11.
[] [PMID: 17032330]
Na SK, Jung H-K, Shim K-N, Jung SA, Chung SS. Iatrogenic rectal diverticulum with pelvic-floor dysfunction in patients after a procedure for a prolapsed hemorrhoid. Ann Coloproctol 2014; 30(1): 50-3.
[] [PMID: 24639972]
Blouhos K, Vasiliadis K, Tsalis K, Botsios D, Vrakas X. Uncontrollable intra-abdominal bleeding necessitating low anterior resection of the rectum after stapled hemorrhoidopexy: Report of a case. Surg Today 2007; 37(3): 254-7.
[] [PMID: 17342370]
Ratto C. THD Doppler procedure for hemorrhoids: The surgical technique. Tech Coloproctol 2014; 18(3): 291-8.
[] [PMID: 24026315]
Elbetti C, Giani I, Novelli E, Martellucci J, Feroci F. Symptomatic pile tailored procedure. A new perspective for hemorrhoidal disease treatment. Ann Ital Chir 2017; 88: 348-51.
[PMID: 29051401]

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