My experience with Minimally Invasive Procedure
for haemorroides using circular stapler
Dr. P. George Mathews, MS. FICS, Chief Surgeon, Carmel Hospital, Aluva
212 cases done from 6th March 2002. How does MIPH work? Excision of excess prolapsed rectal mucosa with partial excision of internal haemorroids. Mucosa is pulled up and anchored into normal anatomical position. Blood flow is interrupted relieving vascular congestion.
Advantages: Can be performed as a day case procedure compared with 3-5 day stay, short operating and anaesthetic time, High patient satisfaction, reduced post-operative pain, earlier return to normal activity and Effective symptoms control.
Most common treatment Ist and IInd degree . Diet, Banding, IRC, Cryo and Scleroscent injection.
IIIrd and IVth degree MIPH or Haemorrhoidectomy. I have offered stapled haemorrhoidectomy
As a modality of treatment to 212 cases till date. Disposable PPH 01 was used. All the patients tolerated the procedure well. Subjective and objective analysis showed a significantly low post-operative pain. All of them were discharged within 24 to 36 hours. Low incidence of post-operative bleeding and no incontinence or stricture.
Discussion The circular stapling device, by excising a circumferential column of mucosa and sub mucosa above the dentate line, achieves an interruption of terminal branches of of the haemorroidal artery thereby reducing flow to sub epithelial space and of the mucus prolapse. In effect, it excises and restores the normal anatomical relation between the anal mucosa and the pile mass with anal sphincter All this virtually results in reducing the mucosal prolapse and repositioning the haemorrhoidal cushion within the anal canal. Although the cost of the stapler was a negative factor in our population the early return to normal work and painless post operative period and less chances of getting recurrence gets over the cost factor.
Conclusion : Use of a circular stapler in the treatment of haemorrohoidal disease was safe, and was associated with fewer complications than conventional haemorrhoidectomy.