The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on circular stapled haemorrhoidectomy.
Internal haemorrhoids develop when cushions of vascular tissue in the anus undergo pathological change. These cushions have an important role in maintaining continence as they function, along with the internal anal sphincter, to allow the complete closure of the anal canal. Haemorrhoids may cause bleeding, faecal soiling, itching, and occasionally pain. The prevalence of haemorrhoids is estimated at between 4% and 34%.
Circular stapled rectal haemorrhoidectomy reduces the size of internal haemorrhoids by interrupting their blood supply, reducing the available rectal mucosa with the potential to prolapse. Whereas conventional surgical haemorrhoidectomy involves excision of haemorrhoidal tissue, anoderm and perianal skin, stapled haemorrhoidectomy simply excises an annulus of rectal mucosa above the haemorrhoids.
After dilatation of the anal canal, a purse string suture is placed four centimetres above the dentate line. Subsequently, a circular stapler is introduced transanally. The anvil of the device is positioned proximal to the purse-string and the suture is tied down on to the anvil. Retraction of the suture pulls the attached rectal mucosa into the stapler. Closure of the anvil and firing of the stapler simultaneously excises a ring of mucosa proximal to the haemorrhoid(s), thus interrupting the blood supply, but maintaining continuity of the rectal mucosa.