SEMI-CLOSED HEMORRHOIDECTOMY BY CIRCULAR STAPLING Download in PDF
This procedure leaves in place 3 open incisions on the edge of the anal canal by\stapling the rectal mucous membrane allowing it to be fixed to the lower rectum and thus at the same time performing a 3 tied pedicle excision during the first phase of the Milligan and Morgan operation .
These two combined procedures result in a semi-closed hemorrhoidectomy (3 mini open cut drains remain) I stress the fact that you must first perform a Milligan and Morgan procedure and then staple and not staple then excise some marisca as is frequently practised in France nowadays.
I) Advantages :
- Removal of external and internal hemorrhoids and the mucous prolapse during the same surgical operation,
- Shrinking external cuts along with the tightening of the anal canal,
- Removal of ligated pedicles,
- The removal of pedicles results in the absence of necrotic oozing of these pedicles (one has only to look at the appearance of the anal canal during a return to surgery for secondaty bleeding for example on day 10),
- Decreased oozing results in less postoperative pain and a shorter duration of this pain. The pain experienced is similar to that of the Longo procedure,
- Faster healing time (around 18 days),
- Lower risk of secondary bleeding when scabs fall off on day 10 after surgery,
- No post-operative marisca as stapling the bridges towards the inside of the anal canal causes tightening.
- Decreasing of the surface of the intra-canalaire wounds due to a reduction and a binding of the rectale membrane,
- Calibration of the anal canal by the circular stapling leading to a decreasing of the postoperative stenosis,
- Corection of an anterior rectocele by stapling.
II) Disadvantages :
- No single technique is ever completely free from disadvantages or complications : Immediate morbidity identical to the other techniques,
- Difficulty of the technique : at the time of stapling, during the second part of the operation after having performed a Milligan and Morgan procedure (the excision of a group of hemorrhoids),
- The need to have sufficient experience with the basics of Longo Hernorrhoidopexy prion to performing this combined semiclosed technique, (Milligan and Morgan technique),
- The systematic use of a stapler to perform this technique which naturally leads to an increase in the cost of the procedure,
- The risk of stenosis increases if the stapling done in the second phase goes too deep taking with it ; the muscularis-care must therefore be taken to ensure that only the supedicial mucosa is perforated
- Technique which is avalable in around 90% of the hemorrhoidectomy whatever the level of the prolapsus,
- The postoperative consequence are more simple with a fastest healing (average of 18 days),
- After the day 10, a decreasing of the postoperative pain,
- Increasing of the pain due to the hemorrhoidopexy but a clear decreasing of the pain thanks to the Milligan and Morgan technique with or without anoplasty,
- This technique needs a kind of apprenticeship (It is needed around 20 procedures).
Actually, we have realized 6700 sugeries with this semiclosed technique from December 2008.
On 100 hemorrhoidectomies :
- 90 % semoclosed,
- 5 % Longo,
- 5 % Milligan and Morgan technique.