What is stapled haemorrhoidectomy?
Haemorrhoids, also known as piles, are clumps of tissue in the anal canal (around the anus and lower rectum) that contains enlarged blood vessels and a surrounding tissue of muscles and elastic fibres. Haemorrhoids are present in everyone, but their swelling is considered abnormal and can cause problems.
Stapled haemorrhoidectomy is a relatively new surgical technique for treating haemorrhoids. The surgery involves the use of a circular stapling device to remove the lining of rectum, and cut the arterial blood vessels that supply the expanded haemorrhoidal tissue, leading to their shrinkage.
The surgery lifts the haemorrhoids higher inside the rectum so that they do not cause you trouble and also limits the blood supply to the haemorrhoids, which causes their shrinkage. It is important to note that stapled haemorrhoidectomy does not remove haemorrhoids; instead it only removes the swollen supporting tissue that caused the haemorrhoids to lapse downwards.
The surgery is performed inside the rectum and is used to primarily treat internal haemorrhoids; however, external haemorrhoids, if present, may also be reduced.
Why do you need stapled haemorrhoidectomy?
Most cases of haemorrhoids can be treated with suitable lifestyles changes, though medication and surgical intervention become necessary for more advanced cases. If other treatments like medication or minimally invasive procedures have not been successful for you or if you are suffering from large haemorrhoids, your doctor may suggest surgery to you.
Stapled haemorrhoidectomy is used to treat severe forms of haemorrhoids (third and fourth degree) that are mostly internal in nature. However, if you suffer from external haemorrhoids too, the surgery will provide you relief from those as well. Sometimes, doctors perform a stapled haemorrhoidectomy and an additional excision to remove the external haemorrhoids.
Since the surgery is performed inside the rectum, and avoids the sensitive skin around the anus, pain associated with the procedure is less. Further, you can resume your normal routine fairly quickly in around twelve days.
Which specialist should you consult if you have any of the signs and symptoms?
Make an appointment with your general practitioner if you are experiencing signs and discomfort associated with haemorrhoids. Your doctor will refer you to a gastroenterologist, who deals with disorders of the digestive system, and/or a colon and rectal surgeon for further evaluation and treatment.
What are the screening tests and investigations before the surgery?
You doctor would be able to diagnose external haemorrhoids by visual examination. Internal haemorrhoids may be identified by the following methodologies:
- Visual inspection – Scopes (anoscope, protoscope or sigmoscope) allow your doctor to examine your lower rectum and colon. These tools aid identification of internal haemorrhoids that are otherwise too soft to be detected through a rectal exam.
- Rectal examination – The doctor will insert a gloved, lubricated finger inside your rectum and look for abnormal growths.
- Colonoscopy – Based on the observations of above tests, your doctor may recommend colonoscopy, which is an extensive examination of the entire colon.
Your doctor will also ask you a number of questions to determine the extent of the problem, such as your noticing the first signs of haemorrhoids, the level of discomfort, your bowel movement habits, dietary information, family history of haemorrhoids or cancer of colon, rectum or anus, or appearance of blood in stools.
What is the procedure for stapled haemorrhoidectomy?
You will be under the effect of general anaesthesia during the entire course of the surgery. Your doctor will insert a circular, hollow tube into the anal canal. Next, a long thread (suture) is woven along the circumference of the anal canal, above the haemorrhoids, and the ends of the suture are pulled out of the anus through the tube. A stapler is placed through the hollow tube with the circular stapling device at its end.
Next, your doctor will pull the ends of the suture, an action that tugs the swollen haemorrhoidal supporting tissue into the jaws of the stapler, and puts the haemorrhoidal tissues back in their normal position in the anal canal. Stapler is fired and it cuts off the ring of expanded haemorrhoidal tissue trapped within the stapler, while simultaneously stapling the upper and lower ends of the cut tissue.
The staples are left inside the body and help in the healing of the cut tissues around the staples. Scar tissues form in the area that further help in anchoring of the haemorrhoidal tissue in the anal canal. Once healing is complete over the next few weeks, the staples fall off and pass unnoticed in stools.
Depending on your condition, you may be discharged from the hospital after few hours or may require overnight stay.
What are the known complications of the surgery?
Stapled haemorrhoidectomy is associated with the following complications:
- Blockage in rectum
- Perforation in rectum
- Difficulty in urination and passing stools
- Sense of fullness or pressure within rectum (generally resolves within few days of surgery)
- Recurrence or relapse
What precautions or steps are necessary to stay healthy and happy before and after stapled haemorrhoidectomy?
The best method to relieve discomfort and prevent haemorrhoids is to keep your stools soft. Eat fibre-rich foods like fruits, vegetables and whole grains or include fibre supplements in your diet and drink plenty of fluids. Don’t strain when passing stools and go as soon as you feel the urge. Exercise also helps in maintaining proper bowel movement along with weight management. Avoid sitting for long periods at a stretch as it can increase pressure on your veins in the anus area.
“Circular Stapled haemorrhoidectomy – an operation to remove haemorrhoids,” Oxford Radcliff e Hospitals, NHS Trust, https://www.ouh.nhs.uk/patient-guide/leaflets/files%5C100617circularstapled.pdf
“Stapled Hemorrhoidectomy,” MedicineNet.com, Jay W. Marks, MD, https://www.medicinenet.com/stapled_hemorrhoidectomy/article.htm
“Stapled haemorrhoidectomy,” WebMD.com, BMJ Group, https://www.webmd.boots.com/digestive-disorders/haemorrhoids-stapled-haemorrhoidectomy
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