[Stapler hemorrhoidectomy. A new alternative to conventional methods].

Conventional, generally accepted methods of hemorrhoidectomy as the methods of choice in the therapy of IIIrd and IVth degree hemorrhoids often involve problems of attaining sufficient mucosa preservation or are technically highly complex. A new surgical procedure, stapler hemorrhoidectomy, is less risky, permits the preservation of more mucosa, and takes significantly less time (only 5 to 15 minutes) than conventional procedures. Especially important is the high degree of acceptance on the part of patients and operators. The operation is based on the principle of a mucosectomy at least 2 cm above the dentate line. A purse-string suture placed 3-4 cm above the dentate line is tied around the stapler shaft (Ethicon Endosurgery SDH 33). Then the resection and stapling of the mucosa are carried out. This procedure effectively reduces mucosa and blocks the end branches of the upper rectal artery, thus stopping venous and arterial blood flow of the hemorrhoidal plexus. During the period April-September 1998 we treated 42 patients with an average age of 55.5 years using stapler hemorrhoidectomy. We treated IIIrd-IVth degree hemorrhoids (in 29% of cases), partial (in 22% of cases) and circular mucosa prolapse (in 49% of cases). The complication rate was 14%; we observed one case of bleeding, two submucosal hematomas, one partially interrupted suture, one short incontinence (I degree after Parks), and one partial recurrence. All complications occurred at the start of application of the new method and could be brought under control with no difficulties; after a short time the patients were without any discomforts whatsoever. In particular, post-operative pain was generally slight, measuring by means of the visual analog scale (VAS) ranging from 0-100. From the day of the operation until the 21st postoperative day the pain score ranged from 0 to 35. The use of analgetics was significantly less, with 50% of the patients not using analgetics on and following the 1st postoperative day. First experiences with stapler hemorrhoidectomy have shown that patients with distinct hemorrhoids and/or mucosa prolapse benefit greatly by this procedure, when indications and operative techniques are correctly used.