Stapled hemorrhoidopexy: no more a new technique

Haemorrhoidal disease affect between 4.4% and 36.4% of the general population. The common symptoms are: bleeding, prolapse, pain, discharge, itching and hampered anal hygiene. There is no correlation between specific symptoms and anatomic grading. Apparently severe looking haemorrhoids can cause relatively few symptoms. Open haemorrhoidectomy, as described by Milligan, has been accepted worldwide as the best choice for treatment of symptomatic haemorrhoids. In 1998, Longo proposed a procedure for haemorrhoidectomy with minimal postoperative pain, no perianal wound requiring postoperative wound care and a relatively short operative time. His technique presented a new notion for treating haemorrhoids as he proposed circumferential rectal mucosectomy that results in mucosal lifting (anopexy). His aim was not excision of the haemorrhoidal tissue but rather restoring anatomical and physiological aspects of the haemorrhoidal plexus. The grading system described by Goligher, is the most commonly used and is based on objective findings and patient history. Stapled hemorrhoidopexy is performed for grade III and IV, for grade II in case of major bleeding. In lithotomy position and spinal anesthesia and after taking all aseptic precautions, the procedure of stapled hemorrhoidectomy was performed according to Longo’s technique. After this surgical procedure, the need to manually reduce prolapse will have been cured in approximately 90% of patients and the overall preoperative symptoms will be much reduced in the great majority. There should be no anal pain. Bowel habits should have returned to a normal pattern without urgency. One year follow-up or longer 11% of patients had remaining or recurrent prolapse, the reintervention rate is about 10%.