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Stapled Hemorrhoidopexy (Longo Procedure)

Procedure for Prolapse and Hemorrhoids (PPH)

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Stapled Hemorrhoidopexy (Longo Procedure)?

Stapled hemorrhoidopexy (Procedure for Prolapse and Hemorrhoids, PPH; Longo procedure) was introduced by Antonio Longo in 1998.

Mechanism: circumferential excision of a 2-3 cm strip of redundant rectal mucosa and submucosa 3-4 cm above the dentate line using a specialized circular stapler.

Action: lifts the prolapsing hemorrhoidal tissue back into anatomic position and interrupts the terminal branches of the superior rectal artery feeding hemorrhoidal cushions.

Advantages over conventional Milligan-Morgan hemorrhoidectomy: significantly less postoperative pain, faster recovery, earlier return to work, no perianal wounds.

Indications: grade III hemorrhoids (prolapse with manual reduction), grade IV (irreducible, in selected cases), circumferential mucosal prolapse without external thrombosis.

Special instrument: PPH stapler (PPH-03 or comparable circular stapler with anvil and cartridge).

Symptoms

Grade III hemorrhoids: prolapse with bowel movements requiring manual reduction.
Grade IV hemorrhoids: irreducible prolapse (in selected cases).
Recurrent hemorrhoidal bleeding with documented internal hemorrhoids.
Mucosal prolapse syndrome.
Failed conservative therapy (rubber band ligation, sclerotherapy, infrared coagulation).
Predominantly internal hemorrhoidal pathology without large external component.
Patient preference for less painful surgical option.

Risk Factors

Predominant external hemorrhoids or thrombosed external piles (relative; consider conventional hemorrhoidectomy).
Active anorectal infection or abscess.
Severe anal stenosis or stricture.
Recent inflammatory bowel disease activity.
Pelvic radiation therapy history.
Severe perianal Crohn disease or fistula.
Inadequate rectal compliance (fixed scarring).

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Persistent hemorrhoidal symptoms despite conservative measures.
  • Recurrent rectal bleeding with normal colonoscopy.
  • Hemorrhoid prolapse requiring manual reduction.
  • Quality of life impact from hemorrhoidal disease.
  • Failed office procedures (banding, sclerotherapy).
  • Mucosal prolapse with intermittent obstructive defecation.

Treatment Methods

01
Pre-procedure: anorectal examination, anoscopy, colonoscopy if not done within 5 years, full blood count, coagulation profile.
02
Bowel preparation: enema or limited oral preparation.
03
Anesthesia: spinal, regional, or general.
04
Patient positioning: lithotomy or prone jackknife.
05
Procedure: insertion of circular anal dilator (CAD) and purse-string suture in rectal mucosa 3-4 cm above dentate line.
06
PPH stapler insertion, closure of the purse string around the anvil; firing the stapler creates the doughnut excision.
07
Hemostasis: inspect staple line for bleeding; oversewing if needed.
08
Postoperative pain management: NSAIDs, paracetamol; less opioid requirement compared to conventional hemorrhoidectomy.
09
Discharge: same day or 24 hours; soft diet, stool softeners, sitz baths.
10
Outcomes: less pain, faster return to activities (5-7 days vs 14-21 days for conventional).
11
Recurrence rate: slightly higher than conventional hemorrhoidectomy (5-10% over 5 years).
12
Complications: bleeding (2-3%), urinary retention (5-10%), staple line infection, rectovaginal fistula (rare), severe persistent pain (rare "PPH syndrome").

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.