Kỹ thuật phẫu thuật LONGO - Stapled Hemorrhoidectomy

PREPARATION: Repeated enemas
POSITION: Prone jackknife
ANESTHESIA: General (preferred due to greater relaxation of sphincter) or epidural

Step 1.

            If not done prior to surgery, perform sigmoidoscopy (Figs. 1 – 3 ).

Figure 1

Figure 2

Figure 3

Step 2.

             Gradual digital anal dilation to allow placement of the PPH anoscope. With four 2–0 silk sutures, secure the anoscope to the perianal skin.

Step 3.

             Insert the open-sided retractor and place a running 3–0 monofilament suture 3–4 cm above the dentate line staying superficial to the
rectal muscle.

Step 4.

            Remove the open-sided retractor and bring the monofilament suture ends through the hemorrhoid circular stapler. Tie a loose knot in the
suture outside the stapler.

Step 5.

            Apply traction on the suture and, in females, perform vaginal exam to confirm that the rectovaginal wall has not been incorporated. If there is thrombus or edema, allow the stapler to remain completely closed for several minutes prior to firing.

Step 6.

            Cut the silk sutures, release the stapler 1 turn, and remove the anoscope and the stapler.

Step 7.

            Reinsert the open-sided retractor and irrigate each quadrant of the staple line, oversewing any bleeding site with a 3–0 Vicryl suture.