46947 Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by stapling

Name of the Procedure:

Hemorrhoidopexy by Stapling (also known as Stapled Hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids - PPH)

Summary

Hemorrhoidopexy by stapling is a minimally invasive surgical procedure used to treat prolapsing internal hemorrhoids. It involves repositioning the hemorrhoids and securing them with a specialized stapling device, reducing symptoms and discomfort.

Purpose

The procedure aims to treat prolapsing internal hemorrhoids, which are swollen and enlarged veins in the rectum that protrude outside the anus. The goals are to reduce pain, bleeding, and prolapse associated with hemorrhoids, and to restore comfort and normal bowel function.

Indications

• Persistent bleeding from internal hemorrhoids
• Painful prolapsing hemorrhoids not responsive to conservative treatments
• Recurrent hemorrhoid episodes
• Patients with symptoms significantly impacting their quality of life

Preparation

• Patients may be instructed to fast for at least 6-8 hours before the procedure.
• Laxatives or enemas may be recommended to clear the bowels.
• Any blood-thinning medications may need adjustment.
• Preoperative assessments such as blood tests and physical exams will be performed.

Procedure Description

1. The patient receives regional or general anesthesia to ensure comfort.
2. A circular stapling device is inserted into the rectum.
3. The prolapsed hemorrhoidal tissue is gently pulled into the stapler.
4. The device staples the hemorrhoidal cushions, cutting off their blood supply, which causes them to retract.
5. Excess tissue is removed, and the staples form a ring inside the rectum to hold the tissue in place.
6. The stapler is removed, and the procedure is complete.

Duration

The procedure typically takes about 30 to 45 minutes.

Setting

Hemorrhoidopexy by stapling is performed in a hospital or surgical center, often as an outpatient procedure.

Personnel

• Surgeon specialized in colorectal surgery
• Anesthesiologist
• Nursing staff
• Surgical technologist

Risks and Complications

• Pain or discomfort following the procedure
• Bleeding
• Infection
• Staple line complications
• Recurrence of hemorrhoids
• Rarely, issues with bowel movements or urinary retention

Benefits

• Minimally invasive with reduced postoperative pain
• Shorter recovery time compared to traditional hemorrhoid surgeries
• Effective relief from prolapsing hemorrhoid symptoms

Recovery

• Patients can usually go home the same day.
• Pain management may involve prescription pain medication or over-the-counter analgesics.
• Patients should avoid straining during bowel movements and may use stool softeners.
• Follow-up appointments are necessary to monitor healing.
• Full recovery typically takes 1-2 weeks, with most patients returning to normal activities within a few days.

Alternatives

• Rubber band ligation
• Sclerotherapy
• Infrared coagulation
• Traditional hemorrhoidectomy
• The choice depends on the severity of hemorrhoids, patient preference, and overall health.

Patient Experience

During the procedure, the patient will be under anesthesia and should not feel pain. Postoperatively, patients may experience mild to moderate pain, manageable with medication. It's essential to follow post-procedure care guidelines to ensure a smooth recovery and reduce the risk of complications.