Stapled Haemorrhoidopexy

Haemorrhoids or Piles are swollen blood vessels at the lower end of the anus and rectum.

When normal these blood vessels form anal cushions which help in continence (control of flatus i.e. passing gas ).

However when they become enlarged , they form lumps which are known as haemorrhoids or piles.

Haemorrhoids are internal ( located inside the rectum ) and external ( develop under the skin around anus ) . The images below illustrate them.

Why do haemorrhoids oocur ?

There is no one definite cause for haemorrhoids. However they are associated with :

• Increased straining at stool
• Constipation
• Heredity
• Pregnancy : when the uterus presses on the pelvic veins and increases pressure inside them.

What are the symptoms of haemorrhoids ?

• Passage of fresh blood from rectum
• Discomfort and itching around anal area
• Pain and swelling if a clot forms inside the haemorrhoid.

How are haemorrhoids treated ?

Haemorrhoids are treated based on their severity.Haemorrhoids have been graded into 4 grades :

Grade 1 : Bleeding but no protrusion or prolapse

Grade 2 : Bleeding with prolapse (haemorrhoids coming out ) during passage of stool but regressing spontaneously after passage of stool.

Grade 3 : Bleeding with prolapse during passage of stool which needs to be pushed back by the patient and then remains inside.

Grade 4 : Bleeding with prolapse during and after passage of stool which remains outside despite being pushed back by the patient.

Grade 1 and Grade 2 haemorrhoids can be managed by conservative measures like medication and / or a minor OP (Out Patient) procedure like banding

Advise for patients with grade 1 and grade 2 haemorrhoids include :

• Diet high in fibre and adequate fluids to prevent constipation.
• A laxative usually at night time for smooth passage of stool.
• An ointment to be applied locally to reduce inflammation of haemorrhoids.
• Oral medication to help reduce bleeding and the size of haemorrhoids.

In certain cases of grade 2 haemorrhoids which do not respond adequately to above treatment , banding is advised.

Haemorrhoid Banding : Essentially this means application of a rubber band at the base (neck) of haemorrhoid.This results in cutting off of the blood supply of the haemorrhoid causing it to shrivel and fall of.It can be done as an OutPatient procedure and may required more than one sitting.

In rare cases of grade 2 haemorrhoids with excessive and resistant bleeding ; surgery is advised.

For Grade 3 and Grade 4 haemorrhoids — surgery is indicated.

There are two options of surgery :

1. Open Haemorrhoidectomy
2. Stapled Haemorrhoidectomy

Open Haemorrhoidectomy : This involves Excision (Removal) of haemorrhoids  after tying their base through which they receive their blood supply. This is the traditional approach. However , if the haemorrhoids involve the full circumference of the anal canal , all of them cannot be excised as the resultant healing will result in scarring and narrowing (stenosis) of the anal canal.The procedure also results in raw areas which take 3-4 weeks to heal and can be painful.

Stapled Haemorrhoidectomy : This is a newer procedure in which the haemorrhoids are not excised but instead pulled up to their original position using a special instrument known as a stapler.This results in early recovery , less pain and earlier return to work.