Stapled Haemorrhoidopexy, Stapled Anopexy, Minimally invasive procedure for haemorrhoids, Procedure for prolapsed Haemorrhoids.
What does the surgery involve?
A stapled haemorrhoidopexy is an operation to return the haemorrhoids to a normal position inside the rectum (back passage). A circular shaped stapling device is gently inserted in the back passage. The surgeon is then able to use the device to remove excess tissue above the haemorrhoids and then staple the remaining tissue back inside the rectum. The staples are left permanently in the body. Stapled haemorrhoidopexy is a relatively new technique, developed in Europe in the early 1990’s, and introduced world over, over the past few years. The National Institute for Clinical Excellence has recently reviewed this procedure (www.nice.org.uk). The evidence they have reviewed suggests that stapled haemorrhoidopexy is as effective as the traditional alternative.
Are there any alternatives?
An alternative to stapled haemorrhoidopexy is a traditional haemorrhoidopexy, which is the surgical removal of haemorrhoids. Whilst this has the advantage of being a tried and tested procedure over many years, it also tends to be more painful and usually requires a longer period of recovery than a stapled haemorrhoidopexy. The other alternative would be transanal haemorrhoidal de-arterialisation or a HALO procedure. During this procedure all of the haemorrhoidal arteries are located and tied using a special device. This will lead to the shrinkage of the haemorrhoids.
You should discuss the risks and benefits of alternatives with your surgeon.
What are the benefits of stapled haemorrhoidectomy?
The main benefits are the relief of pain, bleeding, discharge and itching caused by haemorrhoids.
What are the risks?
Haemorrhoidopexy is considered a safe procedure. However, as with any surgery,
complications do occasionally occur:
1)Bleeding after Surgery: The bleeding often stops spontaneously
but occasionally may need further surgery to correct it. Excessive bleeding
may occur up to 14 days after surgery and this may result in on rare occasions being re-admitted to hospital for observation or treatment.
2)If too much muscle tissue is drawn into the device, it can damage the rectal
wall resulting in inflammation or infection. The internal muscles of the sphincter (entrance to the back passage) may bedamaged, resulting in long-term dysfunction, such as severe pain or incontinence.
3)Immediately after surgery you may also experience some difficulty in passing urine, but this should settle spontaneously. Occasionally a catheter might be required to empty the bladder.
4)Further rare complications of surgery include deep vein thrombosis (DVT) (blood clot), pulmonary embolism (blood clot in the lung), and narrowing of the anus (stenosis).
• 5)Urgency ( the need to rush to the toilet). This can last for a few weeks to months in certain individuals. 6)A very small number of patients have reported long term pain 7)The risks of surgery are assessed on an individual basis, as they can vary
depending if you have any underlying health issues. Please discuss this with your Consultant Surgeon
What would happen if my haemorrhoids were left untreated?
Untreated haemorrhoids can drop down outside the anal canal and strangulate (twist) causing pain. Haemorrhoids can cause leakage of mucous, inflammation and irritation of the skin around the anus. Untreated haemorrhoids can also bleed, so you could become anaemic.
Will the haemorrhoids return after surgery?
Haemorrhoids can return after any form of treatment, but they are less likely to return after having a stapled haemorrhoidopexy. If they do return , rarely another haemorrhoidectomy or other forms of treatment may be necessary.
How long will I be in hospital?
On most of the occasions, especially in the young and fit individuals the procedure is done as a day case, wherein you return home the same day evening. If you do require an overnight stay most likely if you have insurance you will normally be ready for discharge the next day morning.
What happens before the operation?
Prior to admission you will need to have a pre-operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. This will be usually be done by a consultant anaesthetist . The choice of anaesthesia ( Regional or General) will be discussed by your anaesthetist based on your needs
What happens after the operation?
Your blood pressure, pulse and wounds will be monitored closely over the first few hours. You will normally be able to start drinking shortly after the procedure, and can start eating as soon as you are hungry. You will normally be able to get out of bed a few hours after surgery, although the nurses will assist you the first time. Some pain is to be expected. The nurses
will monitor how you are feeling and give you painkillers if required. If an anal plug has been inserted this will usually be removed a few hours after surgery. If a dissolvable anal plug has been used this will be passed on your first bowel movement. A small amount of bleeding is also to be expected. The nurses will monitor the wound site and if necessary provide pads to protect your clothes from marking.
If your operation is planned as a day case you can go home as soon as the effect of the anaesthetic has worn off. A general anaesthetic can temporarily affect your coordination and reasoning skills and hence you would need a responsible adult to take you home and stay with you for the first 24 hours.
During this time it is also important that you do not operate machinery, drive or make important legal decisions.
Before your discharge the nurse/ Doctor will advise you about your post-operative care and will give you a prescription for painkillers and laxatives and an Antibiotic. Your referral Doctor if any also will be notified of your treatment.
If a hospital follow-up appointment is required you will be notified of this prior to discharge.
What activities will I be able to do after my surgery?
You can return to normal physical and sexual activities when you feel comfortable, this is usually quicker than with a conventional haemorrhoidectomy.
How much pain can I expect?
At times the pain may be significant, but generally it is less than with the open
conventional surgery, so taking regular painkillers will help. Warm baths ( Sitz baths) may also help reduce any discomfort. Some patients may experience discomfort for several weeks after the operation.
Bowel action and personal hygiene:
It is important to maintain a regular bowel movement that should be well formed but soft. You should continue to take laxatives for two weeks after your surgery. Eating a high fibre diet and increasing your fluid intake will also help. You will normally open your bowels within two to three days of your operation although this may be uncomfortable at first. You may notice blood loss after each bowel movement but this will gradually reduce over the next few weeks.
It is important to keep the operation site clean. If possible, wash after each bowel action for three to four weeks after the operation. Bathing once or twice a day is also soothing and may reduce discomfort. The cut area may take a month or more to heal properly and during this time there may be a slight discharge. Wearing a small pad inside your pants will protect your clothes from any staining.
When will I be able to drive?
You must not drive for at least 24 hours after surgery. Before driving you should ensure that you are able to perform an emergency stop, have the strength and capability to control the car and be able to respond quickly to any situation that may occur. Please be aware that driving whilst unfit may invalidate your insurance, and you are at risk of causing harm for others.
When can I return to work?
You can return to work as soon as you feel well enough. This could depend on the type of work that you do. Typically you will need one to two weeks off work.
When should I seek help or Emergency treatment?
• 1)If you develop a fever above 101° F (38.5° C) or chills. 2)Vomiting or nausea. 3)Increasing pain, redness, swelling or discharge. 4)Severe bleeding. 5)Difficulties in passing urine. 6)Constipation for more than 3 days despite using laxatives.
Where should I seek advice or help?
Contact your nearest Health centre / Hospital.