Piles Stapler Surgery - Procedure, Benefits and Recovery

Stapler Surgery for Piles

Treatment Duration

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15 Minutes

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30 Minutes

Treatment Cost

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40,000

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55,000

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Stapler Surgery for Piles

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Haemorrhoids (piles) is a prevalent anorectal condition that impacts approximately 4% of the global population. Individuals experiencing piles seek medical attention due to painless bleeding, the protrusion of haemorrhoids, discomfort, or itching.

A technique introduced by Longo in 1998, known as stapled haemorrhoidectomy, has demonstrated superior outcomes and quicker recovery. This makes it a widely accepted choice among surgeons due to reduced postoperative pain and increased patient satisfaction. 

Read below to find out more about stapler surgery for piles, its benefits, procedure, complications, cost, etc.

Procedure Name

Piles Stapler Surgery

Alternative Name

Stapler haemorrhoidectomy, Stapler rectal mucosectomy

Conditions Treated

Grade 3 and 4 piles, Prolapsed piles

Benefits of the Procedure

Minimally invasive, Reduced pain, Faster recovery, Lower risk of complications

Treated by

Proctologist, Anorectal Surgeon, General Surgeon

You can check Stapler Surgery for Piles Cost here.

What is Piles Stapler Surgery?

Usually, first and second-grade haemorrhoids can be effectively managed through dietary changes and suitable medications. However, surgical procedures become necessary for more advanced cases (third and fourth-grade haemorrhoids). 

Stapled haemorrhoidectomy is a minimally invasive procedure for haemorrhoids (MIPH). It is the gold standard method to treat advanced stages of piles.

In a stapled haemorrhoidectomy, the surgery involves cutting the blood vessels within the swollen haemorrhoidal tissue. Thereby reducing blood flow and the size of the haemorrhoids. As the tissue heals, it forms a scar that holds the haemorrhoids in a higher, normal position in the anal canal. 

The staples used in the process fall off on their own after a few weeks and will be excreted with the stool. This procedure can be used for patients with internal and external haemorrhoids, or it may involve combining stapled haemorrhoidectomy for internal haemorrhoids and a simple resection for external haemorrhoids.

Anatomy and Physiology of Anal Region

The anal region, also known as the anorectal region, plays a role in the elimination of stool and the regulation of bowel movements. Nerves and muscles signal the urge for defecation and enable voluntary control to retain stool until excreted.

Upon readiness, these nerves and muscles facilitate stool expulsion from the body. The mucous lining within the anus secretes mucus to lubricate the passage, ensuring the smooth passage of stool.

The anatomy includes:

  1. Anus: The external opening at the end of the digestive tract, through which stool is excreted. Muscles surrounding it assist in the passage of stool.

  2. Anal Canal: A brief passage from the anus to the rectum, lined with a mucous membrane. It can be susceptible to the development of piles. Two types of sphincters encircle it: 

    1. Internal Anal Sphincter: This involuntary smooth muscle remains contracted to control bowel movements and relaxes during defecation.

    2. External Anal Sphincter: These voluntary muscles surround the internal sphincter.

  3. Rectum: The final part of the large intestine temporarily stores stool before excretion. 

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Need for Piles Stapler Surgery?

Doctors recommend stapler haemorrhoidectomy for individuals who haven't experienced significant improvement with non-surgical treatments. Stapler surgery for piles is a gold standard treatment for high-grade piles. The indications are:

  1. Targeted for Advanced Haemorrhoids: Stapler haemorrhoidectomy is typically reserved for higher-grade haemorrhoids, specifically third and fourth degrees.
    Third-degree haemorrhoids can be manually pushed back inside the anus, while fourth-degree haemorrhoids remain outside.

  2. Effective for Persistent Haemorrhoids: While it can be used for second-degree haemorrhoids, stapler haemorrhoidectomy is more commonly recommended for cases with greater severity.
    It addresses piles that extend outside the anus after bowel movements but retract on their own.

  3. Potential Improvement for External Haemorrhoids: Suppose internal haemorrhoids are accompanied by small external haemorrhoids causing issues.
    In that case, stapled haemorrhoidectomy may lead to reduced problems with the external haemorrhoids. The procedure can alleviate complications associated with internal and external haemorrhoids.

Benefits of Piles Stapler Surgery

Stapler surgery for piles addresses the limitations of open haemorrhoidectomy by eliminating persistent spasms of the internal sphincter. It has reduced sequelae and minimal damage to anal cushions and helps retain normal anal canal function.

Maximal retention of anal structure ensures improved postoperative well-being.

The benefits of this procedure are:

  1. Non-invasive Technique: Piles stapler surgery is a minimally invasive procedure that eliminates affected tissue without incisions.

  2. Minimal Blood Loss: This surgery is associated with little to no blood loss, reducing the risk of complications during the procedure.

  3. Low Pain Levels: Patients typically experience minimal pain during and after piles stapler surgery, contributing to a more comfortable recovery process.

  4. No Sutures: Unlike traditional surgeries, piles stapler surgery leaves no open wounds, and there is no need for external stitches, promoting a cleaner and less complicated healing process.

  5. Quick Healing: Treating piles with stapler surgery facilitates faster healing, enabling patients to resume regular activities sooner than conventional methods.

  6. Low Risk of Post-surgical Complications: It effectively lowers the incidence of complications, contributing to a safer surgical experience. These can include complications, such as postoperative haemorrhage, oedema, urinary retention, and anal stenosis.

  7. Reduced Follow-up Visits: Patients undergoing this surgery require fewer follow-up visits, as the procedure is designed to minimise postoperative issues.

  8. Low Recurrence Rate: Stapler surgery has a notably low recurrence rate, indicating a reduced likelihood of the problem returning after the procedure, providing long-term relief for patients.

Protocol Before and On the Day of Piles Stapler Surgery

Individuals often inquire about the process before and on the day of the piles stapler surgery. Adequate preparation beforehand ensures that the patient remains well-informed and aware of what to expect.

Protocol Before Piles Stapler Surgery

Prior to stapler surgery of piles, the medical team follows proper guidelines to ensure smooth surgery. It ensures the safety of the patient throughout the process.

Parameters

Prerequisites

Pre-op Assessment

  1. General, physical and complete proctological examinations (including anorectoscopy or rectosigmoidoscopy) 

  2. Routine laboratory tests


Risk Evaluation

  1. Allergies

  2. Benefits vs risks of the procedure

Anaesthesia Selection

General or Spinal anaesthesia

Mandatory Precautions

  1. Stop blood thinners as directed by the physician.

  2. Quit smoking and alcohol.

  3. Fasting for 6-8 hours.

On the Day of Piles Stapler Surgery

On the day of the surgery, one can expect the following:

Parameter

Prerequisites

Consent

Mandatory

Surgical Preparation

  1. Hospital gown

  2. Briefing of procedure

  3. Removing all accessories like belt, jewellery, watch etc.

  4. Emptying the colon with enema or laxative

Physical Evaluation

Vitals check-up (Blood pressure, heart rate, oxygen saturation, etc.)

IV Line

Yes, for administering medications

Anaesthesia Administration

Regional or spinal anaesthesia

Piles Stapler Surgery Procedure

Stapler haemorrhoidectomy takes 15-20 minutes, quicker than open surgery. The surgeon will perform the procedure under general or spinal anaesthesia. The key steps in the procedure are:

  1. Patient is Positioned: The patient is positioned in the lithotomy position for a clear view of haemorrhoids, and anaesthesia is administered. 

  2. Anal Dilator Placed: An anal dilator is inserted into the anal canal to facilitate the procedure. Then, a purse-string suture is placed approximately 4 cm above the dentate line (inside the rectum, which has a ridged texture).

  3. Circular Stapler Inserted: A circular stapler is introduced transanally. The anvil of the stapler is positioned proximal to the purse-string suture. The suture is tied down onto the anvil. Retraction of the suture pulls the attached rectal mucosa into the stapler.

  4. Stapler Firing: Closure of the anvil and firing of the circular stapler simultaneously excise a ring of mucosa proximal to the haemorrhoid. This process interrupts the blood supply while maintaining the continuity of the rectal mucosa.

  5. Haemostasis and Inspection: After firing, the stapler is kept closed for 30 seconds to achieve haemostasis. The stapling line is inspected.

Expectations After Piles Stapler Surgery

Following surgical treatment, hospitals adhere to a set of protocols dedicated to the recovery of patients. The immediate postoperative process within the hospital extends until the patient's discharge.

Recovery in Hospital

After undergoing stapler piles surgery, patients may experience sedative effects for approximately 4-6 hours. While patients might initially feel nauseous or disoriented, these effects gradually diminish as the anaesthesia wears off.

In-hospital recovery includes:

  1. Postoperative Monitoring: After the surgery, Healthcare professionals closely monitor vital signs such as blood pressure, heart rate, and oxygen levels will be regularly checked to ensure stability.

  2. Pain Management: Following stapler haemorrhoid surgery, pain medications will be prescribed to alleviate discomfort. Some discomfort can be experienced after the surgery.

  3. Discharge: Patients can be discharged after a thorough postoperative examination. The patient should wear loose-fitting clothes for comfort, have someone drive them home, and provide necessary support during this period.

At-home Recovery

Following staler surgery for piles, individuals should acquaint themselves with the recovery process at home to ensure optimal post-surgery progress. The typical recovery time after the surgery is between 2 to 4 weeks. 

At-home recovery includes:

  1. Stool Softeners: Use prescribed laxatives such as Isabgol husk and Triphala to alleviate pain during bowel movements. Follow the provided instructions for optimal results, as they assist in making the passage of stools smoother.

  2. Hygiene and Wound Care: Gently clean the affected area with mild soap and water, then pat dry. Avoid harsh chemicals or vigorous wiping to prevent irritation. These measures contribute to wound hygiene and facilitate healing.

  3. Sitz Bath: Fill a shallow tub with warm water and sit in it for 10 to 15 minutes, two to three times daily. Sitz bath help reduce swelling and provide relief from discomfort.

  4. Dietary Changes: Gradually increase fibre intake through fruits, vegetables, and whole grains. Begin with bland foods like plain rice, bananas, and crackers. Adequate daily water consumption is also essential.

First Follow-up

After undergoing stapler piles surgery, regular follow-up visits are essential to monitor healing progress and address any potential complications. 

The individual will be given a follow-up appointment within 7 to 14 days post-surgery to monitor the healing process. During this follow-up session, the doctor will:

  1. Evaluate Surgical Site: The doctor will carefully examine the healing progress, focusing on any swelling that might indicate excess fluid retention around the wound site.

  2. Assess Complications: The proctologist will thoroughly check for potential complications following the stapler treatment, such as infection, excessive bleeding, or adverse reactions to prescribed medications.

  3. Discuss Pain Management: Based on this information, the proctologist can adjust medications or suggest appropriate pain management techniques.

Risks and Complications of Piles Stapler Surgery

According to research by Hetzer, a decrease in pain during the initial ten days was observed following the operation. Early bleeding is the most common complication associated with stapled haemorrhoidectomy, indicating bleeding that occurs soon after the procedure. 

It's important to note that bleeding occurring during the operation at the staple or suture line is not considered a complication but an anticipated aspect of the procedure. A thorough examination of the entire staple line is crucial for effectively addressing intraoperative bleeding.

Following the surgery, there may be minimal or no bleeding. A risk unique to this procedure is the failure of the stapling gun. It refers to the malfunction or inadequate performance of the stapling device used during stapled surgery.

Various rare complications, including intramural abscess, partial dehiscence (incomplete wound healing), mucosal septum (abnormal tissue partition), and intussusception (telescoping of the intestines), each occur in less than 0.1% of cases. This highlights their infrequent nature. Some rare risks are:

  1. Severe Pain: Approximately 1.7% of patients may encounter intense pain following the stapler surgery, which could contribute to discomfort and reduced quality of life.

  2. Stenosis: In 0.8% of cases, there is a risk of stenosis, which is the narrowing of the anal canal. This can potentially lead to difficulties in bowel movements.

  3. Faecal Urgency: Individuals may experience an urgent need to pass stools, impacting daily activities.

  4. Fissure: The patients may develop anal fissure, or tears in the anal lining, which can cause pain and bleeding.

  5. Urosepsis: It is a complication involving a bacterial infection in the urinary tract that spreads to the bloodstream.

When to See a Doctor?

The patient should be aware of high-risk complications. It can enhance their recovery process. Patients should consult their doctor if experiencing the following complications after piles stapler treatment:

  1. Excessive Discomfort: While postoperative pain and bleeding are typical and usually resolve within 10 days, persistent and severe discomfort needs medical attention.

  2. Fever: A mild fever is common after surgery, but a high-grade fever (above 100 degrees Fahrenheit) may indicate infection. Persistent or high-grade fever should prompt consultation with a doctor for evaluation.

  3. Infection: Signs of infection, such as increased redness, swelling, warmth, or pus drainage from the wound site, should be reported to a doctor promptly to prevent complications.

  4. Bowel Obstruction: While a rare occurrence, stapler piles treatment may lead to bowel obstruction. If a patient experiences severe abdominal pain, bloating, constipation, inability to pass gas, or a bowel movement, immediate medical attention is warranted.

Risks of Delay in Piles Stapler Surgery

Haemorrhoids can recur over time. However, stapler surgery tends to have a lower chance of recurrence than traditional methods. This is possible if the condition has been managed promptly. There are delayed risks not addressed on time, which include:

  1. Risk of Anal Infection: Leaving the condition untreated for an extended period increases the likelihood of developing an anal infection.

  2. Aggravating Piles: Internal haemorrhoids, if not treated, can cause discomfort and complications as they prolapse. Prolapsed piles may become trapped in the anal muscles, causing severe pain.

  3. Thrombosed Piles: Delayed treatment raises the risk of thrombosis, the formation of blood clots around the anus. It causes thrombosed piles.

  4. Potential Anal Fissure: In rare instances, worsening symptoms of piles can lead to additional damage in the anorectal region, such as the development of an anal fissure (damage to the anal tissues).

Cost of Piles Stapler Surgery

The expense for stapler piles surgery falls within the range of ₹ 40,000 to ₹ 55,000. Carious factors influence the overall cost, like:

  1. Consultation Fee: It is essential to have a thorough understanding of the procedure, risks, and benefits before opting for surgery. Consulting with a skilled doctor is advisable, although it may contribute to the total cost.

  2. Surgeon's Fee: Stapler haemorrhoidectomy is a specialised procedure requiring an experienced and well-equipped surgeon. The surgeon's proficiency and experience can impact expenses.

  3. Admission Fee: Piles stapler surgery typically involves a day of hospital stay, influencing the overall surgery cost.

  4. Patient's Age: Haemorrhoids can affect individuals of all ages. Older patients may face more complications during surgery, potentially affecting the cost of stapler piles operation.

  5. Patient's Medical Condition: Patients who are elderly or have a weakened immune system may require additional attention, impacting the treatment expenditure.

  6. Location or City: The cost of stapler treatment for piles in India may differ based on the hospital's location. Generally, metropolitan cities have higher prices than smaller or more remote towns.

  7. Diagnostic Test Cost: Before stapler surgery, patients undergo diagnostic examinations such as digital rectal examination, sigmoidoscopy, and colonoscopy. The tests contribute to the pricing structure.

  8. Post-Surgery Complications: Complications arising from stapler surgery may occur. The cost of managing these complications is factored into the overall operational expenses.

Procedure

Cost

Stapler Surgery for Piles

₹ 40,000 to ₹ 55,000

Takeaway

For individuals seeking relief from piles, stapler surgery is an efficient choice. This approach alleviates pain, facilitates healing, and helps prevent the recurrence of the condition.

This non-invasive procedure ensures a quicker recovery, enhances overall quality of life, and lowers the chances of complications.

Schedule a free online consultation with HexaHealth to know more aboutstapler piles surgery. You can discuss your condition, including the benefits and considerations of stapler surgery, with one of our top healthcare providers. 

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Frequently Asked Questions (FAQ)

Pile stapler surgery, also known as stapled haemorrhoidectomy, is a minimally invasive medical procedure. It uses a stapling device to remove excess haemorrhoidal tissue, especially in grades III and IV.

This relieves symptoms like bleeding and discomfort with potentially quicker recovery.

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The piles stapler treatment may be beneficial as it offers a less invasive option. It reduces postoperative pain and has a faster recovery compared to traditional surgery.

The procedure effectively addresses piles by using a stapling device to remove excess haemorrhoidal tissue, relieving symptoms.



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The benefits of stapler surgery for piles are:

  1. Less invasive procedure

  2. Reduced postoperative pain

  3. Faster recovery

  4. Lower risk of complications, such as bleeding and infection

  5. Fewer follow-up

  6. No to least recurrence

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Recovery time after piles stapler surgery varies in patients. Most of them can resume normal activities within a week. However, follow the doctor's postoperative care instructions to ensure a smooth recovery.

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While stapler surgery for piles is generally safe, some potential disadvantages include:

  1. Bleeding

  2. Infection at the stapler site

  3. Recurrence of piles

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The steps in the stapled haemorrhoidectomy procedure are: 

  1. The patient is positioned in the lithotomy position.

  2. General or spinal anaesthesia is administered to ensure comfort during the procedure.

  3. A stapling device is inserted into the anal canal to remove excess tissue and reposition haemorrhoids.

  4. The stapler simultaneously staples and cuts the excess tissue without any incision. It reduces the blood flow to the haemorrhoids.

  5. Patients are advised on postoperative care, including pain management and dietary recommendations, to facilitate a smooth recovery.

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Compared to traditional surgery, stapler haemorrhoidectomy is less invasive, potentially resulting in reduced pain and quicker recovery. The procedure has minimal or no blood loss, so there are no complications.

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There are rare complications in the case of stapler haemorrhoidopexy. It includes:

  1. Bleeding: There is a risk of postoperative bleeding, though generally minimal.

  2. Pain: While it is less painful than traditional surgery, discomfort may still occur during recovery.

  3. Infection: The stapler site can get infected, which is rare. It can be managed with appropriate care.

  4. Recurrence: Some patients may experience a recurrence of haemorrhoids over time.

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Complete recovery can take a month, but to ensure smooth recuperation, one must follow  the post-op guidelines diligently. It may include:

  1. Pain Management: Over-the-counter pain relievers and prescribed medications can help manage postoperative pain.

  2. Dietary Changes: A high-fibre diet and increased water intake can prevent constipation and promote smoother bowel movements.

  3. Personal Hygiene: Maintaining good personal hygiene, including gentle cleaning of the anal area, helps prevent infection.

  4. Avoid Straining: Patients are advised to avoid straining during bowel movements to minimise stress on the surgical site.

  5. Follow-up Appointments: Regular follow-up appointments with the doctor are essential to monitor progress and address any concerns during recovery.

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Stapler haemorrhoidectomy is generally considered effective and less painful than traditional haemorrhoidectomy, with a potentially faster recovery. However, the choice between the two depends on individual factors.

Discussing the options with a doctor is advisable to determine the most suitable approach based on specific health conditions.

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The following diet is recommended post-stapler surgery to enhance recovery:

  1. High-Fibre Foods: Include fruits, vegetables, whole grains, and legumes to promote regular bowel movements and prevent constipation.
  2. Adequate Hydration: Drink plenty of water to stay hydrated, which aids digestion and helps soften stools.
  3. Limit Processed Foods: Reduce processed and spicy food intake, which may irritate the digestive system.
  4. Avoid Straining: Stick to foods that are easy to digest and do not require excessive straining during bowel movements.
  5. Small, Frequent Meals: Opt for smaller, more frequent meals to ease digestion and prevent digestive system overload.

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Stapler surgery for piles is generally suitable for adults of various age groups, but the decision is based on individual health conditions rather than strict age restrictions.

Doctors assess each patient's overall health to determine the appropriateness of the procedure, considering factors such as medical history and existing health issues.

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Stapler treatment for piles is generally not recommended during pregnancy due to potential risks. Pregnant women experiencing haemorrhoidal symptoms are advised to explore alternative options. 

It can include dietary modifications, topical treatments, and consulting their healthcare provider for safe management during pregnancy.



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The common indications for opting stapler treatment for piles are:

  1. Persistent Symptoms: When conservative measures like dietary changes and medications fail to relieve persistent symptoms such as bleeding and discomfort.

  2. Bleeding: If there is ongoing rectal bleeding despite other conservative treatments.

  3. Advanced Haemorrhoids: In grade III or IV haemorrhoids, stapler haemorrhoidectomy may be considered when it is not responding well to less invasive treatments.

  4. Prolapsed Haemorrhoids: When haemorrhoids protrude from the anal opening, causing discomfort and hindering daily activities.

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References

All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.


  1. Cristea C, Lewis CR. Hemorrhoidectomy. [Updated 2023 Jul 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.link
  2. Nahas SC, Borba MR, Brochado MC, Marques CF, Nahas CS, Miotto-Neto B. Stapled hemorrhoidectomy for the treatment of hemorrhoids. Arq Gastroenterol. 2003 Jan-Mar;40(1):35-9. doi: 10.1590/s0004-28032003000100008. Epub 2003 Oct 6. PMID: 14534663.link
  3. Yang J, Cui PJ, Han HZ, Tong DN. Meta-analysis of stapled hemorrhoidopexy vs LigaSure hemorrhoidectomy. World J Gastroenterol. 2013 Aug 7;19(29):4799-807. doi: 10.3748/wjg.v19.i29.4799. PMID: 23922480; PMCID: PMC3732855.link
  4. Mascagni D, Zeri KP, Di Matteo FM, Peparini N, Maturo A, Berni A. Stapled hemorrhoidectomy: surgical notes and results. Hepatogastroenterology. 2003 Nov-Dec;50(54):1878-82. PMID: 14696423.link
  5. Kumar M, Pankaj D, Kumar N, Abhishek K, Bhushan V, Tajdar Y, Kumari P, Muni S. A Prospective Study Comparing Stapler and Open Surgical Technique of Hemorrhoidectomy. Cureus. 2023 Mar 17;15(3):e36304. doi: 10.7759/cureus.36304. PMID: 37077600; PMCID: PMC10108892.link
  6. Lan P, Wu X, Zhou X, et al. The safety and efficacy of stapled hemorrhoidectomy in the treatment of hemorrhoids: a systematic review and meta-analysis of ten randomized control trials. 2006. In: Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centrlink
  7. Jaiswal SS, Gupta D, Davera S. Stapled hemorrhoidopexy - Initial experience from a general surgery center. Med J Armed Forces India. 2013 Apr;69(2):119-23. doi: 10.1016/j.mjafi.2012.08.015. Epub 2012 Nov 30. PMID: 24600083; PMCID: PMC3862944.link
  8. Majumder KR, Alam TA, Rassell M. LASER Haemorrhoidoplasty versus Stapler Haemorrhoidopexy: A Prospective Comparative Study. Mymensingh Med J. 2021 Jul;30(3):780-788. PMID: 34226468.link
  9. Ravo B, Amato A, Bianco V, Boccasanta P, Bottini C, Carriero A, Milito G, Dodi G, Mascagni D, Orsini S, Pietroletti R, Ripetti V, Tagariello GB. Complications after stapled hemorrhoidectomy: can they be prevented? Tech Coloproctol. 2002 Sep;6(2):83-8. doi: 10.1007/s101510200018. PMID: 12402051.link
  10. Lumb KJ, Colquhoun PH, Malthaner RA, Jayaraman S. Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev. 2006 Oct 18;2006(4):CD005393. doi: 10.1002/14651858.CD005393.pub2. PMID: 17054255; PMCID: PMC8887551.link
  11. Sturiale A, Fabiani B, Menconi C, Cafaro D, Celedon Porzio F, Naldini G. Stapled Surgery for Hemorrhoidal Prolapse: From the Beginning to Modern Times. Rev Recent Clin Trials. 2021;16(1):39-53. doi: 10.2174/1574887115666200310164519. PMID: 32156241.link
  12. Athar A, Chawla T, Turab P. Stapled hemorrhoidopexy: The Aga Khan University Hospital experience. Saudi J Gastroenterol. 2009 Jul-Sep;15(3):163-6. doi: 10.4103/1319-3767.45358. PMID: 19636176; PMCID: PMC2841414.link
  13. Araujo SE, Horcel LA, Seid VE, Bertoncini AB, Klajner S. LONG TERM RESULTS AFTER STAPLED HEMORRHOIDOPEXY ALONE AND COMPLEMENTED BY EXCISIONAL HEMORRHOIDECTOMY: A RETROSPECTIVE COHORT STUDY. Arq Bras Cir Dig. 2016 Jul-Sep;29(3):159-163. doi: 10.1590/0102-6720201600030008. PMID: 27759778; PMCID: PMC50link
  14. Cerato MM, Cerato NL, Passos P, Treigue A, Damin DC. Surgical treatment of hemorrhoids: a critical appraisal of the current options. Arq Bras Cir Dig. 2014 Jan-Mar;27(1):66-70. doi: 10.1590/s0102-67202014000100016. PMID: 24676303; PMCID: PMC4675486.link
  15. Porrett LJ, Porrett JK, Ho YH. Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg. 2015 Jan;100(1):44-57. doi: 10.9738/INTSURG-D-13-00173.1. PMID: 25594639; PMCID: PMC4301293.link
  16. Bota R, Ahmed M, Aziz A. Is Stapled Hemorrhoidectomy a Safe Procedure for Third and Fourth Grade Hemorrhoids? An Experience at Civil Hospital Karachi. Indian J Surg. 2015 Dec;77(Suppl 3):1057-60. doi: 10.1007/s12262-014-1140-4. Epub 2014 Jul 16. PMID: 27011510; PMCID: PMC4775568.link
  17. Singer M, Abcarian H. Stapled hemorrhoidopexy: the argument for usage. Clin Colon Rectal Surg. 2004 May;17(2):131-42. doi: 10.1055/s-2004-828660. PMID: 20011258; PMCID: PMC2780042.link

Reviewer

Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

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Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More

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Sangeeta Sharma

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