Stacker hemorrhoidopexy

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The stapler hemorrhoidopexy according to Longo , engl. Procedure for Prolapse & Hemorrhoids (PPH) is a surgical procedure for the surgical treatment of abnormally enlarged hemorrhoids . This is a relatively new procedure that is less invasive and therefore promises less pain and faster healing compared to traditional operations.

field of use

For 3rd degree prolapsed hemorrhoids. In contrast to the conventional procedure (hemorrhoidectomy), the hemorrhoidal nodes are not removed, but are brought back into their natural anatomical position by lifting the mucous membrane (shortening the mucous membrane and submucosa ). Hemorrhoidal cushions develop from the age of 10 and are necessary for fine continence (sealing off gases and liquids).

history

SN Koblandin and JL Schalkow, two Kazakh surgeons, first described the procedure in 1981. The Italian surgeon Antonio Longo perfected it in Palermo until 1997. The procedure is based on the development of a new surgical tool, the stacker . In the meantime, the application is quite widespread, especially in Italy and Germany.

technology

Longo hemorrhoid surgery

First, the anal canal is carefully widened to make it easier to insert the device. For further preparation, an all-round suture is placed in a relatively pain-insensitive area above the hemorrhoids in the rectum .

Then a special Rundschneide- and bracket device (which is truck , according to the English word for 'stapler') into the anus introduced and pushed back the prolapsed tissue. The device opens when the surgeon only inserts the movable device head a little deeper. With the help of the previously laid seam, excess tissue is pulled into the cavity within the device that is now accessible. When the device is then closed, a ring, usually approx. 3 cm wide, is punched out of the mucous membrane. The "firing" of the forklift leaves a double row of staggered titanium clips all around, which fix the hemorrhoid pads underneath and the anal skin back to their natural position (anal lifting) without affecting these pain-sensitive areas. The surgical site is then examined with a proctoscope for the correct position of the staple line and any remaining bleeding wounds, which can then be closed with additional normal sutures.

This surgical technique requires above-average experience from the surgeon; it is by no means a beginner's operation. In particular, the surgeon has little view and no possibility of fine-tuning the exact course of the seam.

course

The operation is performed under regional or general anesthesia and requires two to three days of hospitalization (inpatient). Occasionally, it is also carried out on an outpatient basis. However, very few doctors consider this advisable because of the risk of heavy bleeding.

The pain after the operation is considerably less than with the classic methods of hemorrhoidectomy , especially when compared to Milligan-Morgan or Parks . The healing and restoration of the patient's ability to work also take place comparatively faster.

Risks and Complications

  • Even after the operation, there may still be heavy bleeding from the staple suture, which may require another operation to stop the bleeding. This risk can be minimized if even minor bleeds are sewn over immediately at the end of the operation.
  • There is little risk that too much muscle tissue will be drawn into the device , damaging the rectal wall and, in women, possibly the wall to the vagina .
  • In extreme cases, the sphincter muscle could be overstretched, which results in temporary or permanent weakness in the wind and stool ( fecal incontinence ).
  • In particular, if the staple sutures are too deep (aborally), but also if the operation is carried out properly, there may be a reduced warning time and constant urge to defecate (urge syndrome).
  • For very large hemorrhoids, treatment may fail if access to the anal canal is difficult or the tissue is too immobile to get far enough inside the device.
  • Recently, critics point out that the rectum at the surgical site is narrowed by the staples and sutures to the diameter of the stacker device (approx. 33 mm). Initial studies claim that there is a significantly higher risk of rectal narrowing compared to traditional surgical methods.
  • As with all operations, there is of course the risk of infection or injury due to the surgeon's inattention.

literature

Individual evidence

  1. ↑ SN Koblandin, JL Schalkow: A new method for the treatment of hemorrhoids with the help of a circular stacker . In: Scientific archive of the Zelinograd Medical Institute, Kazakhstan. 1981, pp. 27-28.

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