Stapled hemorrhoidopexy

Abstract

The search for a less painful operation for treating hemorrhoids has always been a major concern for colorectal surgeons, and stapled hemorrhoidopexy has represented an important step in this direction. The possibility of using a circular stapler in the treatment of hemorrhoids was first proposed by Allegra in 1990 [1], but the originality of Longo's procedure [2] lay in his proposal to treat hemorrhoids by resecting a circular ring of prolapsed mucosa above the dentate line rather than completely removing the hemorrhoids. Since its introduction into clinical practice in 1998, stapled hemorrhoidopexy (SH) has divided coloproctologists, opposing those who favor this new technical approach in any clinical situation to those who are against it, a priori, in all situations. In the middle there is a wiser category of surgeons who prefer to appraise the best treatment for different clinical presentations of hemorrhoids and to use all the arrows available to the coloproctologist's bow, selecting the best option for the individual patient. Since 1997 about 550,000 patients have been treated with stapled hemorrhoidopexy worldwide (personal communication by Ethicon EndoSurgery SpA) and more than 270 papers have been indexed in MEDLINE, confirming the high interest around the world in this new treatment. © Springer-Verlag London Limited 2009.