F.S. Pinheiro RegadasS.M. Murad RegadasL.V. RodriguesR. MisiciI. TramujasJ.B. BarretoM. Alvaro LinsF. Roberto SilvaF.S.P. Regadas Filho New devices for stapled rectal mucosectomy: a multicenter experience

Stapled mucosectomy is widely performed, but in patients with deep gluteal cleft and small distance between the ischial tuberosities, it is difficult to insert the PPH dila- tor. We report the results achieved with a new device, the EEA 34-mm circular stapler (Auto-Suture, New Haven, USA). Eighty-five patients (45 men) were submitted to sta- pled mucosectomy for treatment of third- (n=70) ro fourth- degree fourth (n=10) hemorrhoids or mucosal prolapse (n=5) by surgeons at four different centers. The patients' mean age was 53.9 years (range, 45-70 years). ASA Kit (Advanced Surgical Anoscope) consists of four devices: a circular anal dilator (CAD) with anterior and posterior wings, an accessory device for insertion of CAD into the anal canal, a circular surgical Anoscope (CSA) with proxi- mal and distal openings for placing the rectal mucosal purse- string sutures, and a CSA insertion device. The middle part of the CSA is fully circular in order to avoid that the piles or the prolapsed mucosal fall into the anoscope. The mean excised mucosa band width was 4.7 cm. The mean operative time was 16 min (range, 12-25 min). Bleeding from the sta- pled suture was observed in 10 patients (11.7%). There were

[1]  A. Habr-Gama,et al.  Stapled hemorrhoidectomy: Initial experience of a Latin American group , 2003, Journal of Gastrointestinal Surgery.

[2]  L. Rodrigues,et al.  Transanal repair of rectocele and full rectal mucosectomy with one circular stapler: a novel surgical technique , 2005, Techniques in Coloproctology.

[3]  H. Ortiz,et al.  Stapled Hemorrhoidopexy vs. Diathermy Excision for Fourth-Degree Hemorrhoids: A Randomized, Clinical Trial and Review of the Literature , 2005, Diseases of the colon and rectum.

[4]  M. Pescatori,et al.  Reinterventions After Complicated or Failed Stapled Hemorrhoidopexy , 2004, Diseases of the colon and rectum.

[5]  M. Pescatori,et al.  Bleeding, incontinence, pain and constipation after STARR transanal double stapling rectotomy for obstructed defecation , 2003, Techniques in Coloproctology.

[6]  W. Brough,et al.  Objective Comparison of Stapled Anopexy and Open Hemorrhoidectomy , 2002, Diseases of the colon and rectum.

[7]  M. De Fazio,et al.  Combined Perineal and Endorectal Repair of Rectocele by Circular Stapler , 2002, Diseases of the colon and rectum.

[8]  M. Pescatori,et al.  Which surgical approach for rectocele? A multicentric report from Italian coloproctologists , 2001, Techniques in Coloproctology.

[9]  Y. Ho,et al.  Stapled hemorrhoidectomy—cost and effectiveness. randomized, controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months , 2000, Diseases of the colon and rectum.

[10]  J. Hartley,et al.  Stapling procedure for haemorrhoids versus Milligan-Morgan haemorrhoidectomy: randomised controlled trial , 2000, The Lancet.

[11]  D. Hemingway,et al.  Circumferential mucosectomy (stapled haemorrhoidectomy) versus conventional haemorrhoidectomy: randomised controlled trial , 2000, The Lancet.

[12]  N. Palasciano,et al.  Treatment of external anorectal mucosal prolapse with circular stapler , 1999, Diseases of the colon and rectum.

[13]  A. Longo.  TREATMENT OF HEMORRHOID DISEASE BY REDUCTION OF MUCOSA AND HEMORRHOIDAL PROLAPSE WITH A CIRCULAR SUTURING DEVICE: A NEW PROCEDURE , 1998 .