Stapled hemorrhoidopexy: a new device and method of performance without using a pursestring suture.
OBJECTIVE
This study was designed to develop a more reliable device and technique that will allow for the safer and reproducibly consistent performance of a stapled hemorrhoidopexy without using a pursestring suture. This device and technique must allow the surgeon to be able to control the volume of tissue drawn into the stapler center chamber during the performance of the procedure.


METHODS
A porcine model was used to evaluate and perfect a mucosal impalement device and technique for use during the performance of a stapled hemorrhoidopexy. A specially manufactured washer with spikes on one side was fitted onto the center shaft of a PROXIMATE PPH01 Hemorrhoidal Circular Stapler and was used in each of nine animals. A pursestring suture was not needed and was not used in any of the procedures.


RESULTS
After performing the stapled hemorrhoidopexy, a mucosal donut was obtained from each animal. On gross inspection, each donut was of similar size, height, and volume compared with that of a human stapled hemorrhoidopexy donut. Each was completely circumferential (except for the final specimen, which was purposely incomplete after having performed a single quadrant resection). The performance of each procedure required approximately one minute.


CONCLUSIONS
A procedure and device have been developed that allow for the rapid, safe, and reliable performance of a sutureless stapled hemorrhoidopexy by using a new mucosal impalement device and technique in the porcine model. It was used successfully in the porcine model under simulated diverse clinical circumstances. The procedure is easy to teach and learn and has potential applicability for use in humans.
Hoffman
Gary H
GH
Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California, USA.
D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D006484:Hemorrhoids / Q000601:surgery*; D013536:Suture Techniques / Q000295:instrumentation*; D013537:Sutures; D013552:Swine; D016896:Treatment Outcome