title: New approach to large haemorrhoidal prolapse: double stapled haemorrhoidopexy.
abstract: OBJECTIVE
  To verify if in large haemorrhoidal prolapse (independently from the degree) in patients with no symptoms of obstructed defaecation syndrome, the use of a stapled hemorrhoidopexy variant, comprising a double stapler haemorrhoidopexy (DSH), makes it possible to reduce the percentage of failures or relapses and to standardise an objective intraoperative parameter for the purpose of quantifying internal prolapses which can then be used as a guide in determining the type of treatment to be provided.
  
  
  METHODS
  Between June 2003 and June 2004, 353 patients were treated for haemorrhoidal prolapse. The patients suffering from large haemorrhoidal prolapse occupying more than half of the length of the anal dilator were intraoperatively selected for DSH.
  
  
  RESULTS
  Eighty-three patients (23.5%) underwent a DSH. The degrees of the large haemorrhoidal prolapse intraoperatively selected for DSH were sub-divided as follows: 7.2% (second), 24% (third) and 68.6% (fourth). The follow-up period was 48 months. There were three cases (3.6%) of residual illnesses and five cases (6%) of a relapse. The following complications were recorded: urgency at <3 months (7.2%), haemostasis revisions (2.4%) and spontaneously draining anterior haematoma (1.2%). The results of the 270 haemorrhoidal prolapse (38 second degree, 159 third degree and 130 fourth degree) treated with the procedure for prolapse and haemorrhoids were: nine (3.3%) residual illness and 12 (4.44%) relapse illness. The following complications were recorded: urgency at <3 months (6.6%), haemostasis revisions (2.5%) and spontaneously draining anterior haematoma (0.7%).
  
  
  CONCLUSIONS
  The intraoperative selection criterion was both efficacious and reproducible. This variant technique, which can be used in large haemorrhoidal prolapses, could allow us to further improve the quality of treatment for haemorrhoidal conditions using stapled haemorrhoidopexy, without increasing the complications.
authors: General Surgery Unit IV, S. Chiara Hospital, Pisa, Italy. g.naldini@ao-pisa.toscana.it
authors: Gabriele
authors: G
authors: Naldini
authors: Jacopo
authors: J
authors: Martellucci
authors: Pasquale
authors: P
authors: Talento
authors: Angelo
authors: A
authors: Caviglia
authors: Luca
authors: L
authors: Moraldi
authors: Mauro
authors: M
authors: Rossi
mesh_terms: D000328:Adult; D000368:Aged; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011391:Prolapse; D013537:Sutures; D055815:Young Adult