Stapler Hemorrhoidopexy Procedure and Outcomes

Fundamental Mechanism and Technical Execution

The American Gastroenterological Association notes that stapler hemorrhoidopexy is a surgical technique that removes a ring of redundant rectal mucosa above the anal canal, using a modified circular stapling device, with the dual goals of resuspending prolapsing hemorrhoidal tissue back within the anal canal and interrupting arterial inflow through the excised segment, as described by the procedure's introduction by Longo in 1998 1
The technique differs fundamentally from traditional hemorrhoidectomy in that it does not directly excise the hemorrhoidal tissue itself, external hemorrhoids and skin tags are not removed, and the procedure works by lifting and repositioning prolapsed tissue rather than cutting it out 1

Stapler hemorrhoidopexy demonstrates significantly reduced postoperative pain in all eight randomized controlled trials, with more rapid return to normal activities (within 8-12 days versus 2-4 weeks for conventional surgery), shorter operating times, and shorter hospital stays (typically 1-2 days) 1, 2
The procedure has comparable complication, continence, and recurrence rates to conventional hemorrhoidectomy, with most patients requiring only oral analgesics after the initial postoperative period 1, 2

The most serious complications of stapler hemorrhoidopexy share a common denominator: inadvertent excision of full-thickness rectal wall rather than mucosa and submucosa only, which can lead to rectal perforation, retroperitoneal sepsis, and pelvic sepsis 1, 3, 2
Additional complications include internal anal sphincter fragmentation in 14% of patients when using the standard 37-mm anal dilator, smooth muscle fibers detected in variable percentages of specimens, and standard hemorrhoidectomy complications such as urinary retention, bleeding, anal stenosis, infection, and incontinence 1, 4, 2

Patients must understand that external hemorrhoids and skin tags will not be addressed by this technique, and if external disease is significant, conventional hemorrhoidectomy may be more appropriate 1, 2
A systematic review concluded that efficacy compared to conventional hemorrhoidectomy could not be determined due to paucity of long-term data, but individual studies report higher recurrence rates compared to conventional hemorrhoidectomy 5