3 The technology
3.1 Stapled haemorrhoidopexy is a technique that reduces the prolapse of haemorrhoidal tissue by excising a band of the prolapsed anal mucosa membrane above the dentate line, using a specific circular stapling device. This interrupts the blood supply to the haemorrhoids and reduces the potential for available rectal mucosa to prolapse. The procedure is referred to as a 'pexy' because the haemorrhoidal tissue is not excised as in conventional haemorrhoidectomy. Stapled haemorrhoidopexy is also known as 'procedure for prolapse and haemorrhoids' (PPH), stapled anopexy, stapled prolapsectomy and stapled mucosectomy. It has been used in the UK for at least 2 to 3 years.
3.2 Two devices were identified in this appraisal: the HCS33 device (models PPH01 and PPH03, Ethicon Endo-Surgery) and the Autosuture stapler (Tyco Healthcare), which can be used in conjunction with the STRAM kit adaptor to perform haemorrhoidopexies.
3.3 The cost of the HCS33 PPH03 stapling device, the model currently in use, is £420 based on the submission from Ethicon Endo-Surgery. Costs may vary in different settings because of negotiated procurement discounts. The cost of the Autosuture stapler with the STRAM kit adaptor was not available.