Thomas P. Sokol, MD, FACS, FASCRS
Thomas P. Sokol, MD received his medical degree from the University of Health Sciences/The Chicago Medical School in 1980. He went on to his general surgical residency at Harbor/UCLA Medical Center and then to the Carle Clinic/ University of Illinois for Fellowship Training in Colon and Rectal Surgery.
What are hemorrhoids?
Hemorrhoids are defined as an abnormally enlarged vein, mainly due to persistent increase in venous pressure, occurring within or just outside the anal sphincter of the rectum. The anal canal is the last four centimeters through which stool passes as it goes from the rectum to the outside world. The anus is the opening of the anal canal to the outside world.
Although most people think hemorrhoids are abnormal, they are present in everyone. It is only when the hemorrhoidal cushions enlarge that hemorrhoids can cause problems and be considered abnormal or a disease.
Prevalence of hemorrhoids
Although hemorrhoids occur in everyone, they become large and cause problems in only 4% of the general population. Hemorrhoids that cause problems are found equally in men and women, and their prevalence peaks between 45 and 65 years of age.
What is stapled hemorrhoidectomy?
Stapled hemorrhoidectomy is surgical technique for treating hemorrhoids, and is the treatment of choice for third-degree hemorrhoids (hemorrhoids that protrude with straining and can be seen on physical exam outside the anal verge. Persistent or intermittent manual reduction is necessary). Stapled hemorrhoidectomy is a misnomer since the surgery does not remove the hemorrhoids but, rather, the abnormally lax and expanded hemorrhoidal supporting tissue that has allowed the hemorrhoids to prolapse downward.
For stapled hemorrhoidectomy, a circular, hollow tube is inserted into the anal canal. Through this tube, a suture (a long thread) is placed, actually woven, circumferentially within the anal canal above the internal hemorrhoids. The ends of the suture are brought out of the anus through the hollow tube. The stapler (a disposable instrument with a circular stapling device at the end) is placed through the first hollow tube and the ends of the suture are pulled. Pulling the suture pulls the expanded hemorrhoidal supporting tissue into the jaws of the stapler. The hemorrhoidal cushions are pulled back up into their normal position within the anal canal. The stapler then is fired. When it fires, the stapler cuts off the circumferential ring of expanded hemorrhoidal tissue trapped within the stapler and at the same time staples together the upper and lower edges of the cut tissue.
Who is a good candidate for stapled hemorrhoidectomy?
Stapled hemorrhoidectomy, although it can be used to treat second degree hemorrhoids (hemorrhoids that extend outside the anus after a bowel movement or straining, but return inside by themselves), usually is reserved for higher grades of hemorrhoids - third and fourth degree. Third degree hemorrhoids can be pushed back into the anus with a finger after a bowel movement. Fourth degree hemorrhoids are always outside. If in addition to internal hemorrhoids there are small external hemorrhoids that are causing a problem, the external hemorrhoids may become less problematic after the stapled hemorrhoidectomy. Another alternative is to do a stapled hemorrhoidectomy and a simple excision of the external hemorrhoids. If the external hemorrhoids are large, a standard surgical hemorrhoidectomy may need to be done to remove both the internal and external hemorrhoids.
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