Procedure for prolaps and hemorrhoids (PPH) is a technique for the treatment of severe prolapsing hemorrhoids. Compared with traditional methods, it has the advantages of less pain and shorter hospital stay, but it also has certain complications, such as anal bulging and anastomotic stenosis. This is largely due to excessive mucosal resection.
Tissue-selecting therapy stapler (TST) is based on the distribution of hemorrhoids, selectively resecting and anastomosing the hemorrhoids to reduce trauma and complications.
(1) Cure or significantly change the preoperative symptoms;
(2) The average operation time is short, ranging from 8 to 12 minutes;
(3) The normal working time is short;
(4) There are few postoperative complications, and there are generally few serious complications;
(5) Hemorrhoids do not recur in a short time.
The starting point of TST design is based on the modern concept of hemorrhoids and the concept of minimally invasive treatment, and its mechanisms include:
(1) Selectively remove the mucosa and submucosa at the end of rectum about 3 cm on the hemorrhoids, and complete the anastomosis at one time, which can lift the hemorrhoid tissue and restore it to its original position;
(2) The blood supply from the inferior rectal artery is completely removed, which significantly reduces the congestion and hypertrophy of hemorrhoids, and can restore the original size of hemorrhoids;
(3) After the anal cushion was lifted and reset, the normal anatomical structure of the anal canal area was restored, and the pelvic floor muscles gradually returned to normal functions. Since the anal cushion tissue is preserved to the greatest extent, the anal canal area anatomy and tissue structure are intact, and there is no incision in the perianal area with rich sensory nerve endings, theoretically TST can not only solve the hemorrhoid surgery better It is a minimally invasive technique that can minimize the complications of anal swelling, disability, and anastomotic stenosis caused by traditional PPH surgery.
TST operation method (1) Preoperative bowel preparation, choose spinal anesthesia or intrasacral anesthesia, take prone folding knife position, and routinely disinfect the perineum. (2) According to the number and size of hemorrhoids, choose the suitable anoscope for a single hemorrhoid with a single-port anoscope; 2 hemorrhoids with a two-port anoscope; 3 hemorrhoids with a three-port anoscope. (3) Expand the anus moderately, insert the anoscope, remove the inner tube, and rotate the anoscope so that the hemorrhoid mucosa to be resected is located in the open-loop window. (4) A single hemorrhoid can be sutured with a submucosal suture at 3 to 4 cm above the hemorrhoid. Two hemorrhoids can be sutured with two mucosal sutures or can be sutured with a single thread at a time. Three hemorrhoids can be sutured in segments. If the hemorrhoids are large and prolapsed, double purse-string lead traction is feasible. Suture is only performed on the mucosa and submucosa to avoid injury to the muscle layer. (5) Unscrew the tail wing of the stapler counterclockwise. After the head of the stapler and the body are completely loosened, insert the head of the stapler into the anal expander, tighten the purse string around the central rod, and pass it through the seam. The thread lead-out rod leads the suture out of the side hole of the stapler body, continues to pull, and tighten the stapler clockwise, the prolapsed rectal mucosa is pulled into the staple groove of the stapler through the window of the anoscope. Resistance, the pointer of the indicator window of the stapler shows that it enters the firing range. Married women check whether there is sewn to the back wall of the vagina. Open the fuselage insurance, fire, complete the cutting and anastomosis. After fixing the stapler body and waiting for 30 s, loosen the tail wing counterclockwise for 3~turns, and pull out the stapler. (6) Observe the anastomosis. If there is a suture bridge between the two anastomoses, it can be cut directly; the protruding parts at both ends are respectively clamped and double-ligated with "7" silk thread. If there is active bleeding, the "8" stitch is used to stop the bleeding. The compound carrageenate was received in the anus, and the surgical resection specimens were examined and sent for pathological examination.
"Keep as much normal tissue as possible" is an important concept of surgery, and it is also applicable to the treatment of hemorrhoids. If the normal tissue between the hemorrhoids can be preserved, and only the hemorrhoid mucosa and submucosa tissues with diseased hemorrhoids can be removed, it should be a very good ideal. TST is undoubtedly a good choice for hemorrhoids treatment.