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External Haemorrhoids: These are swellings that develop
outside the anus while passing stools. Massive haemorrhoids are prolapsed haemorrhoids more than 3-4 cm outside the
anal verge. An effective modified stapled haemorrhoidectomy technique where excess mucosa was first excised before the stapler
was applied has been described to deal with such massive haemorrhoidal prolapse.19 Another more expensive alternative
might be to use two staplers at the same sitting.
Conventional haemorrhoidectomy therefore deals with the
symptoms alone without due regard to restoration of the normal physiology by re-fixation of the anal cushions.
Chronicity is caused by a vicious cycle of
prolapse and congestion of these vascular cushions.
On the other hand, stapled haemorrhoidopexy tries to correct the primary pathology, theoretically resulting in resolution of haemorrhoidal symptoms.15 After reduction of any prolapsed haemorrhoidal tissue,
this technique then excises redundant lower rectal mucosa, fixing the prolapse back into its proper place on the
wall of the anal canal. If you’ve had chickenpox as a child, the virus will
often remain dormant in nerve tissue, but if it comes back when you’re an adult, it will typically be much more painful than chickenpox.
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