Campos Fábio Guilherme, Moraes Paula Gabriela Melo, Martins Pablo Veloso, Bustamante-Lopez Leonardo Alfonso, Martinez Carlos Augusto Real
Department of Surgery, Medical School, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
Hospital das Clínicas, Medical School, Universidade de São Paulo (USP), São Paulo (SP), Brazil.
Sao Paulo Med J. 2025 Aug 11;143(4):e2023435. doi: 10.1590/1516-3180.2023.0435.R1.29112024. eCollection 2025.
Surgical treatment of hemorrhoidal disease has undergone numerous modifications in recent decades. Among the technical options, stapled hemorrhoidopexy is currently considered an optimal alternative because it provides a less painful recovery. However, many reports have associated this technique with higher recurrence rates than excisional techniques.
This manuscript presents a technical modification that aims to provide more extensive mucosectomy with mechanical hemorrhoidopexy.
The present technical modification was developed and has been recently used in two hospitals in São Paulo (SP), Brazil.
To achieve this, we placed a circumferential submucosal suture at the 3 o'clock position in the clockwise direction. When the left lateral position (9 o'clock) was reached, a loop of 2-0 non-absorbable suture thread was passed around the continuous suture and retracted to the left. Subsequently, the original suture progressed towards the point on the right lateral side, where it was started.
Specifically, the modification consists of establishing two traction points from the pursestring suture; thus, the rectal mucosa entering the stapler head will be more uniform, and the retrieved mucosal strip will present a greater height. These features may play a role in effectively reducing mucosal prolapse and alleviating the symptoms.
The proposed modification of the original operative technique is simple and aims to improve postoperative results by increasing the height of the mucosal specimen to be resected, thereby reducing long-term recurrence. In the future, this hypothesis will be tested in a randomized study comparing the mucosectomy height and postoperative outcomes of both technical options (classical and present).
近几十年来，痔病的外科治疗经历了众多改良。在各种技术选择中，吻合器痔上黏膜环切术目前被认为是一种理想的替代方法，因为它能使恢复过程疼痛较轻。然而，许多报告指出该技术的复发率高于切除技术。
本文介绍一种技术改良方法，旨在通过机械性痔固定术实现更广泛的黏膜切除。
本技术改良方法已研发出来，最近在巴西圣保罗市的两家医院应用。
为实现这一目标，我们在3点钟位置沿顺时针方向放置一圈黏膜下缝线。当到达左侧卧位（9点钟）时，将一根2-0不可吸收缝线绕过连续缝线并向左牵拉。随后，原来的缝线继续向右侧开始的点推进。
具体而言，该改良方法包括从荷包缝线上建立两个牵引点；这样，进入吻合器头部的直肠黏膜会更均匀，切除的黏膜条高度也会更高。这些特点可能有助于有效减少黏膜脱垂并缓解症状。
对原手术技术的改良方法简单，旨在通过增加待切除黏膜标本的高度来改善术后效果，从而降低长期复发率。未来，将通过一项随机研究对这两种技术方案（传统方法和改良方法）的黏膜切除高度及术后结果进行比较，以验证这一假设。
