title: Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus.
abstract: OBJECTIVE
  The aim of the study was to assess the results of the stapled transanal procedure in the treatment of hemorrhoidal prolapse in terms of postoperative complications and recurrence rate using a new dedicated device, TST Starr plus.
  
  
  METHODS
  Patients affected by III-IV degree hemorrhoidal prolapsed that underwent stapled transanal resection with the TST Starr plus were included in the present study. Results of the procedure with perioperative complications, postoperative complications, and recurrence rate were reported.
  
  
  RESULTS
  From November 2012 to October 2014, 52 patients (19 females) were enrolled in the study. The main symptoms were prolapse (100 %) and bleeding (28.8 %). Transanal rectal resection was performed with parachute technique in 24 patients (46.2 %) and purse string technique in 23 patients (53.8 %). A mild hematoma at the suture line occurred in one patient (1.9 %). Postoperative bleeding was reported in three patients (5.7 %), in one of which, reoperation was necessary (1.9 %). Tenesmus occurred in one patient (1.9 %), and it was resolved with medical therapy. Urgency was reported in nine patients (17.1 %) at 7 days after surgery. Of these, three patients (5.7 %) complained urgency at the median follow-up of 14.5 months. Reoperation was performed in one patient (1.9 %) for chronic anal pain for rigid suture fixed on the deep plans. Occasional bleeding was reported in four patients (7.7 %). No recurrence of prolapse was reported at a median of 14.5 months after surgery, even if one patient (1.9 %) had a partial recurrent prolapse of a downstaged single pile.
  
  
  CONCLUSIONS
  TST Starr plus seems to be safe and effective for a tailored transanal stapled surgery for the treatment of III-IV degree hemorrhoidal prolapse. The new conformation and innovative technology of the stapler seems to reduce some postoperative complications and recurrence rate.
authors.affiliation: Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Naldini
authors.affiliation: Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Fabiani
authors.affiliation: Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Menconi
authors.affiliation: Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy.
authors.forename: I
authors.initials: I
authors.lastname: Giani
authors.affiliation: Proctological and Perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Toniolo
authors.affiliation: General, Emergency and Minimally Invasive Surgery, Careggi University Hospital, Largo Brambilla 3, 50134, Firenze, Italy. jamjac64@hotmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Martellucci
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000601:surgery; D059350:Chronic Pain / Q000209:etiology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006484:Hemorrhoids / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000209:etiology; D012005:Rectal Prolapse / Q000601:surgery*; D012008:Recurrence; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D016896:Treatment Outcome
keywords: Hemorrhoids; Prolapse; Rectal resection; STARR; Stapler