Abstract
An optimal stapled haemorrhoidopexy requires the purse-string suture to be placed circumferentially at a constant distance from the dentate line and to pass through an appropriate thickness of rectal mucosa. An unsuitable purse-string suture may increase the risk of postoperative complications. We developed a new anoscope (the videoanoscope) to prevent the difficulties during application of the purse-string suture, and we used the videoanoscope in 18 stapled haemorrhoidopexy procedures. The videoanoscope is made up of three pieces. The front part is in the form of an open half-cylinder. The second piece is a sliding lid that covers the front piece. The rear part of the anoscope includes a hollow handle in which a scope can be inserted, and the whole procedure can be transmitted to a monitor via this scope. The opening on the anoscope can be adjusted by sliding the lid. A purse-string suture is placed on the rectal mucosa protruding through this adjustable opening. The anoscope is rotated to apply the subsequent suture bites and when the starting point is reached again the purse-string is completed. Then the stapled haemorrhoidopexy procedure is continued in the usual fashion. Videoanoscope-assisted stapled haemorrhoidopexy was easily performed in 18 patients (12 men, 6 women; mean age 48.9 years). The mean operative time was 32.8 minutes. The excised rectal mucosal rings were complete in all of the patients. Optimal purse-string depth was reflected in the presence of only mucosa and submucosa in all specimens, without incorporation of muscle cells. Postoperative complications were urinary retention in one patient and bleeding in five patients, one of whom requiring sutures for haemostasis. Further studies are required to assess the potential advantages of this technique.
Similar content being viewed by others
References
Plocek MD, Kondylis LA, Duhan-Floyd N et al (2006) Hemorrhoidopexy staple line height predicts return to work. Dis Colon Rectum 49:1905-909
Pescatori M, Aigner F (2007) Stapled transanal rectal mucosectomy ten years after. Tech Coloproctol 11:1-
Ravo B, Amato A, Bianco V et al (2002) Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol 6:83-8
Bozdag AD, Nazli O, Tansug T et al (2007) Special anoscope for easy purse-string suture application in stapled hemorrhoidopexy. World J Surg 31:538-41
Jayne DG, Seow-Choen F (2002) Modified stapled haemorrhoidopexy for the treatment of massive circumferentially prolapsing piles. Tech Coloproctol 6:191-93
Bulut A, Evcimen S, Kaya O, Hoca O (2006) Comparison of the Milligan Morgan hemorrhoidectomy and stapled hemorrhoidopexy for the treatment of the hemorrhoidal disease (in Turkish). Turk J Surg 22:67-1
Au-Yong I, Rowsell M, Hemingway DM (2004) Randomised controlled clinical trial of stapled haemorrhoidectomy vs conventional haemorrhoidectomy; a three and a half year follow up. Colorectal Dis 6:37-8
Pescatori M, Gagliardi G (2008) Complications after procedure for prolapsing hemorrhoids (PPH) and stapled transanal rectal resection (STARR). Tech Coloproctol 12:7-9
Ravo B, Amato A, Bianco V et al (2002) Complications after stapled haemorrhoidectomy; can they be prevented? Tech Coloproctol 6:83-8
Kam MH, Mathur P, Peng XH et al (2005) Correlation of histology with anorectal function following stapled hemorrhoidectomy. Dis Colon Rectum 48:1437-441
Regadas FS, Regadas SM, Rodrigues LV et al (2005) New devices for stapled rectal mucosectomy: a multicenter experience. Tech Coloproctol 9:243-46
Racalbuto A, Aliotta I, Corsaro G et al (2004) Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial. Int J Colorectal Dis 19:239-44
Senagore AJ, Singer M, Abcarian H et al; Procedure for Prolapse and Hemorrhoids (PPH) Multicenter Study Group (2004) A prospective, randomized, controlled multicenter trial comparing stapled hemorrhoidopexy and Ferguson hemorrhoidectomy: perioperative and one-year results. Dis Colon Rectum 47:1824-836
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bozdag, A.D., Nazli, O., Tansug, T. et al. Videoanoscope-assisted stapled haemorrhoidopexy: analysis of 18 patients. Tech Coloproctol 12, 123–126 (2008). https://doi.org/10.1007/s10151-008-0410-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10151-008-0410-1