Haemorrhoidectomy: Stapled

Described by Italian Longo in 1993
For Grade (2), 3 or 4 haemorrhoids that are not fixed externally
Claimed less post op pain

Contraindicated if only 1 prolapsing cushion

Beware rectovaginal fistula (do VE prior to firing)

Steps:
Insert anal dilator and obdurator
Insert purse string anoscope
Place purse string at least 5cm from dentate line. 2-0 prolene suture into mucosa NOT muscle
Purse string anoscope withdrawn and stapling device inserted with anvil maximally extended
Purse string tightened and single throw before suture ends retrieved through ports in stapler with crotchet hook
With moderate traction the purse string is drawn into the casing
Close stapler, hold for 30 seconds then fire. On completion the suture line should be 2-3cm above dentate line