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Stapled hemorrhoidectomy, more accurately called stapled hemorrhoidopexy, is a minimally invasive surgical technique used to treat internal hemorrhoids, particularly advanced (Grade III–IV) disease associated with prolapse and bleeding. Instead of removing hemorrhoidal tissue directly, the procedure repositions and reduces prolapsing hemorrhoids by removing a circumferential ring of rectal mucosa and submucosa above them and securing the tissue with a circular stapling device.
This shifts hemorrhoidal tissue back to its normal anatomical position and reduces blood flow to the hemorrhoidal cushions, leading to shrinkage and symptom relief.
Unlike conventional excisional hemorrhoidectomy — which removes hemorrhoidal bundles — stapled hemorrhoidopexy:
Targets tissue above the hemorrhoids (in the rectum)
Removes a circumferential strip of mucosa
Lifts and re-suspends prolapsed hemorrhoidal tissue
Interrupts part of the blood supply feeding hemorrhoids
Uses a circular stapling device to simultaneously cut and staple
Because the work is done higher in the rectum — where there are fewer pain-sensitive nerve endings — postoperative pain is often significantly reduced compared with traditional excisional surgery.
Stapled hemorrhoidectomy is typically considered for:
Best suited for:
Grade III internal hemorrhoids (prolapse requiring manual reduction)
Grade IV internal hemorrhoids (irreducible prolapse)
Circumferential mucosal prolapse
Symptomatic internal hemorrhoids with bleeding and prolapse
Patients seeking less postoperative pain and faster recovery
Not ideal for:
Predominantly external hemorrhoids
Large thrombosed external hemorrhoids
Significant mixed internal–external disease
Anal stenosis or certain anorectal anatomy limitations
Patient under regional or general anesthesia
Anal dilator inserted to expose rectal canal
Purse-string suture placed in rectal mucosa above hemorrhoids
Circular stapling device positioned
Purse-string tightened to draw tissue into stapler
Stapler fired:
Removes ring of mucosa/submucosa
Staples remaining tissue together
Hemorrhoidal cushions repositioned upward
Staple line inspected for bleeding
Hemostasis secured if needed
Typical operative time: 20–40 minutes
Compared with conventional excisional hemorrhoidectomy:
Less postoperative pain
Faster recovery
Earlier return to work and activity
Shorter operative time
Minimal external wounds
Lower need for strong narcotic pain medication
Reduced wound care requirements
Slightly higher recurrence rates in some studies
Not suitable for large external hemorrhoids
Specialized equipment required
Risk if staple line placed too low (increased pain)
Technical precision is critical
May not address external skin tags
While generally safe, potential complications include:
Common:
Temporary bleeding
Urinary retention
Mild postoperative discomfort
Urgency or pressure sensation
Less common but important:
Staple line bleeding
Infection
Persistent pain
Recurrence or persistent prolapse
Anal stricture (rare)
Rectal perforation (very rare but serious)
Proper patient selection and surgical expertise significantly reduce risk.
Immediately after surgery:
Often same-day discharge
Mild to moderate pressure sensation
Minimal wound care needed
First week:
Bowel movements may feel unusual but manageable
Stool softeners recommended
Light activity encouraged
Return to normal activity:
Often within a few days
Work return commonly within 3–7 days
Full activity per surgeon guidance
Stapled hemorrhoidopexy provides:
Excellent symptom relief for prolapsing internal hemorrhoids
High patient satisfaction when properly selected
Faster functional recovery vs excisional surgery
Best results when used for internal prolapse rather than external disease
