New devices for stapled rectal mucosectomy: a multicenter experience

Stapled mucosectomy is widely performed, but in patients with deep gluteal cleft and small distance between the ischial tuberosities, it is difficult to insert the PPH dilator. We report the results achieved with a new device, the EEA 34-mm circular stapler (Auto-Suture, New Haven, USA). Eighty-five patients (45 men) were submitted to stapled mucosectomy for treatment of third- (n=70) or fourth-degree (n=10) hemorrhoids or mucosal prolapse (n=5) by surgeons at four different centers. The patients' mean age was 53.9 years (range, 45-70 years). ASA Kit (Advanced Surgical Anoscope, Tecplast Company, Fortaleza, Brazil) consists of four devices: a circular anal dilator (CAD) with anterior and posterior wings, an accessory device for insertion of CAD into the anal canal, a circular surgical anoscope (CSA) with proximal and distal openings for placing the rectal mucosal purse-string sutures, and a CSA insertion device. The middle part of the CSA is fully circular in order to avoid that the piles or the prolapsed mucosa fall into the anoscope. The mean excised mucosal band width was 4.7 cm. The mean operative time was 16 min (range, 12-25 min). Bleeding from the stapled suture was observed in 10 patients (11.7%). There were 5 postoperative complications (5.9%): 3 perianal hematomas and 2 stapled suture strictures. Anopexy was considered excellent by the surgeons in 50 patients (58.8%), good in 25 (29.4%) and poor in 10 (11.7%). At a mean follow-up of 12 months, proctoscopy demonstrated residual asymptomatic small internal prolapses in 15 patients (17.6%). Full pile prolapses recurred in 2 (2.3%) and required diathermy excision. ASA Kit made stapled mucosectomy easier to perform, but it's necessary to improve the circular staplers to adequately treat all sizes of mucosal and hemorrhoidal prolapses in order to reduce the recurrence rates.