Piles Stapler Surgery - Procedure, Benefits and Recovery

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. 

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.

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.

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.

On the Day of Piles Stapler Surgery

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

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.

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.

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.

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).

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.

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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