A stapled hemorrhoidectomy, also known as a Procedure for Prolapse and Hemorrhoids (PPH), is a surgical technique used to address symptomatic hemorrhoids. This procedure treats internal hemorrhoids that have prolapsed or become enlarged. Its primary goal is to reposition affected tissue within the anal canal and reduce blood supply to the hemorrhoidal cushions, promoting shrinkage and alleviating discomfort.
The Role of Surgical Staples
Surgical staples used in a stapled hemorrhoidectomy are made from titanium, a biocompatible material resistant to corrosion from bodily fluids. These internal staples differ from those used to close skin incisions, which are usually removed after external healing.
During the procedure, a specialized circular stapling device is inserted into the anal canal. This device is used to excise a circular strip of tissue above the hemorrhoids, lifting the prolapsed tissue back into place. The staples simultaneously join the cut edges, forming a new circumferential suture line and effectively reducing the blood flow to the hemorrhoids.
How the Body Handles the Staples
The titanium staples placed during a stapled hemorrhoidectomy are not designed to dissolve or be absorbed by the body. Instead, the body’s natural healing process involves the formation of scar tissue around these foreign objects. This encapsulation helps to secure the newly repositioned tissue and maintain the integrity of the staple line.
Over a period of weeks to months, as the tissue continues to heal and remodel, the staples may gradually loosen. This natural loosening is part of the ongoing tissue reorganization within the rectal canal. Some of these loosened staples may eventually detach from the tissue.
While some staples are expelled, a significant portion may remain embedded within the healed tissue. Most staples are retained after stapled hemorrhoidectomy, contrary to a common belief that all are shed. These retained staples do not cause issues and are often imperceptible to the patient.
Post-Procedure Staple Passage
It is normal for patients to pass some or all surgical staples in their stool. This expulsion occurs over several weeks to a few months following the stapled hemorrhoidectomy. Patients may notice these small, shiny pieces, often described as tiny ‘B’ shapes, approximately 3mm wide.
The passage of these staples is not painful and indicates that healing and tissue remodeling are progressing as expected. Occasionally, minor bleeding may occur with staple passage, which is considered normal. Maintaining soft bowel movements through adequate hydration and fiber intake can help facilitate this process.
Patients should contact their healthcare provider if they experience excessive pain, significant or persistent bleeding, or any signs of infection. While rare, complications such as inflammatory polyps at the staple line can sometimes cause late bleeding, which may require medical evaluation.