Proctology

Minimally Invasive Procedure For Hemorrhoids

In proctology, ‘hemorrhoids’ is a common term. It is also known as ‘piles’ and is associated with swollen veins in the lower rectum or anus. While there are risks involved with the condition, there are also techniques for its minimization. Here, we are going to discuss the minimally invasive procedure for hemorrhoids, that is, Hemorrhoidopexy or Stapled hemorrhoidopexy. In this surgical process, the surgeon removes an abnormally enlarged hemorrhoidal tissue. The remaining hemorrhoidal tissue is repositioned back to its normal anatomical position. Unlike the conventional Hemorrhoidectomy that involves severe complications like anal fistula, excessive bleeding, or acute constipation, the Stapled Hemorrhoidopexy is relatively safer. However, the procedure to be adopted entirely depends on the severity of the case.

DEVELOPMENT AND INDICATIONS OF MICR (STAPLED HEMORRHOIDOPEXY)

An Italian surgeon, Dr. Antonio Longo, Department of Surgery, University of Palermo, first elaborated this process in 1993. Since then, it has been under a lot of clinical trials, and it was in 2003 that the National Institute of Clinical Evidence in the UK issued full guidance on the procedure & stated it to be safe. Owing to this fact, it became widely accepted as a wound-free procedure for hemorrhoids.

The process is for the 3rd and 4th degrees of internal hemorrhoidal prolapse that requires surgery. It is also for those patients who have minor degree hemorrhoids but are non- responsive towards conservative treatment. It may be contra-indicated in case of single cushion prolapse or in fibrotic piles where physical repositioning is not feasible.

PROS AND CONS OF STAPLED HEMORRHOIDOPEXY

PROS

• It requires less time to operate.
• It involves minimal loss of blood.
• Post-operative complications such as pain, bleeding, are lower.
• Hospital stays are not too long in this case.
• It involves fast recovery and early return to work and daily activities.
• The recurrent rate is low.
• The process does not affect the heart, kidneys, or other parts of the body.

CONS

• Toilet bleeding occurs in some cases.
• It occasionally involves staple line stricture.
• There are risks of contracting infection.
• It also involves an uncontrollable urge for a toilet.

Old risks involved in (MIPH)

• Feeling of needing to rush.
• He toilet bleeding.
• Staple line stricture
• Infection

Indication of MIPH (STEPLER)

Whatever the indications might be, the main aim is to reduce post-operative complications and soothe a patient’s sensitive perianal area. And it is best achieved with MICR.

• Grade 3 hemorrhoids that comes to be pushed in.
• Grade 4 hemorrhoids that (prolapsed out and cannot be pushed in) are found to be on manipulation at the surgery.