How to do Safe Stapled Hemorrhoidectomy or Stapled Hemorrhoidopexy – Lecture by Dr. R. K. Mishra at World Laparoscopy Hospital

Stapled Hemorrhoidectomy, also known as Stapled Hemorrhoidopexy, is an advanced surgical technique designed for the treatment of advanced Hemorrhoids. In a detailed academic lecture at World Laparoscopy Hospital, renowned laparoscopic surgeon Dr. R. K. Mishra explained the principles, steps, and safety measures required to perform a safe and effective stapled hemorrhoidectomy. The lecture focused on surgical precision, patient safety, and the advantages of this minimally invasive approach over conventional hemorrhoid surgery.

Stapled Hemorrhoidopexy is primarily indicated for patients suffering from grade III and grade IV prolapsing hemorrhoids. Unlike traditional hemorrhoidectomy, this technique does not remove the hemorrhoids directly. Instead, it corrects the prolapse by removing a circumferential ring of redundant rectal mucosa above the hemorrhoids. This repositioning reduces blood flow to the hemorrhoidal tissue and pulls the prolapsed tissue back to its normal anatomical position. Because the procedure is performed above the dentate line where pain receptors are minimal, patients usually experience significantly less postoperative pain.

During the lecture, Dr. R. K. Mishra emphasized the importance of proper patient selection and thorough preoperative evaluation. Conditions such as thrombosed hemorrhoids, external hemorrhoids without prolapse, or inflammatory bowel diseases may not be suitable for stapled hemorrhoidopexy. Careful assessment ensures optimal outcomes and reduces the risk of complications.

The surgical procedure begins with proper positioning of the patient, usually in the lithotomy position. After administering appropriate anesthesia, an anal dilator is gently inserted to expose the anal canal. A purse-string suture is then placed circumferentially in the rectal mucosa approximately 3–4 cm above the dentate line. This step is critical because accurate placement of the suture ensures that the stapler removes the correct amount of mucosa without damaging surrounding structures.

Once the purse-string suture is secured, a circular stapling device is introduced into the anal canal. The suture is tied around the shaft of the stapler, which pulls the prolapsed mucosa into the stapling device. When the stapler is fired, it excises a ring of mucosa and simultaneously staples the remaining tissue together. This action lifts the prolapsed hemorrhoidal tissue back into its normal position and interrupts its blood supply.

Safety during the procedure is of paramount importance. Dr. R. K. Mishra highlighted several precautions to ensure a safe operation. Surgeons must ensure that the purse-string suture is evenly placed and does not include the muscular layer of the rectum. Including muscle tissue can lead to serious complications such as bleeding, pain, or rectal injury. After firing the stapler, the surgeon should always inspect the stapled line carefully for bleeding points and ensure hemostasis.

Another critical step discussed in the lecture was checking the “doughnut specimen” – the circular ring of tissue removed by the stapler. A complete and symmetrical doughnut confirms that the tissue has been properly excised. An incomplete specimen may indicate technical errors and requires immediate attention.

The advantages of stapled hemorrhoidopexy include reduced postoperative pain, shorter hospital stay, quicker return to daily activities, and minimal wound care. However, Dr. R. K. Mishra also cautioned surgeons that improper technique may lead to complications such as bleeding, stenosis, or recurrence. Therefore, proper training and adherence to standardized surgical steps are essential.

The lecture at World Laparoscopy Hospital serves as an important educational resource for surgeons seeking to master this procedure. Through detailed demonstrations and clinical insights, Dr. R. K. Mishra provided a comprehensive understanding of how to perform stapled hemorrhoidectomy safely and effectively.

In conclusion, stapled hemorrhoidopexy represents a significant advancement in the surgical management of hemorrhoids. With correct technique, careful patient selection, and attention to surgical safety, this procedure offers excellent outcomes and improved patient comfort. The educational efforts of experts like Dr. R. K. Mishra continue to help surgeons worldwide adopt safer and more effective minimally invasive surgical practices.