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Stapler treatment for piles

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Stapler Surgery and Treatment for Piles

Stapling is used to treat prolapsed hemorrhoids. A surgical staple fixes the prolapsed hemorrhoid back into place inside the rectum and cuts off the blood supply so that the tissue will shrink and be reabsorbed. Stapling recovery takes less time and is less painful than recovery from a hemorrhoidectomy.
Procedure for Prolapse and Haemorrhoides (PPH) also known as Minimal invasive Procedure for Haemorrrhoids (MIPH) procedure was first described by an Italian surgeon – Dr. Antonio Longo, Department of Surgery, University of Palermo – in 1993 and since then has been widely adopted through Europe. This procedure avoids the need for wounds in the sensitive perianal area and, as a result, has the advantage of significantly reducing the patient’s postoperative pain. Follow-up on relief of symptoms indicate a similar success rate to that achieved by conventional haemorrhoidectomy. This procedure is for internal hemorrhoids only and not for external hemorrhoids or anal fissures. Since PPH was first introduced it has been the subject of numerous clinical trials and in 2003 the National Institute of Clinical Evidence (NICE) in the UK issued full guidance on the procedure stating it was safe and efficacious.
PPH is generally indicated for the more severe cases of internal hemorrhoidal prolapse (3rd and 4th degree) where surgery would normally be indicated. It may also be indicated for patients with minor degree haemorrhoids who have failed to respond to conservative treatments. The procedure may be contra-indicated when only one cushion is prolapsed or in severe cases of fibrotic piles which cannot be physically repositioned.
In addition to correcting the symptoms associated with the prolapse, problems with bleeding from the piles are also resolved by this excision. Although the cushions may be totally or partially preserved, the blood supply is interrupted or venous drainage is improved by the repositioning. Any external component which remains will usually regress over a period of 3–6 months. Prominent skin tags may, on occasion, be removed during the operation but this may increase the postoperative pain.
PPH employs a unique circular stapler which reduces the degree of prolapse by excising a circumferential strip of mucosa from the proximal anal canal. This has the effect of pulling the hemorrhoidal cushions back up into their normal anatomical position. Usually, the patient will be under general anesthetic, but only for 20–30 minutes. Many cases have been successfully performed under local or regional anesthesia and the procedure is suited to day case treatment.\
Due to the low level of post-operative pain and reduced analgesic use, patients will usually be discharged either the same day or on the day following surgery. Most patients can resume normal activities after a few days when they should be fit for work. The first bowel motion is usually on day two and should not cause any great discomfort. Staples may be passed from time to time during defecation. This is normal and should not be a cause for concern.
Since 2002 more than 100 articles have been published reporting complications during and after stapled hemorrhoidectomy.
Bleeding is the most common postoperative complication. Severe postoperative pain could be caused by dehiscence of the anastomosis or due to the fact that the anastomosis is too near to the linea dentata. Many long-term complications have been described. Most of them are related to either an incorrect indication for surgery or technical errors. Several authors stated that although it seems to be an easy operation to perform, it should only be done by experienced surgeons. Irreversible urge incontinence due to lesions of the sphincter muscle or a diminished rectal capacity due to resection of too much mucosa, are quite common complications if the procedure is not performed properly. Rectovaginal fistulas and anastomotic diverticula are very rare but possible.

stapler surgery and treatment for piles