Tailored prolapse surgery for the treatment of haemorrhoids and obstructed defecation syndrome with a new dedicated device: TST STARR Plus

Abstract

The new device seems to be safe and effective for a tailored approach to anorectal prolapse due to haemorrhoids or obstructed defecation.

Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus

“…Recurrence prolapse is more likely to be due to failure of the stapler to remove an adequate volume of prolapsing tissue. For this reason, TST Starr plus was introduced with the aim to be able to resect more volume of tissue when it is necessary in relation of the entity of the prolapse [14]. In this series, the maximum volume resected was 16 cc and the maximum high of surgical specimen was 7 cm.…”

“…After introducing the circular anal dilator (CAD), surgeon evaluated prolapsed tissue drawing it into the CAD, using a gauze held by a pincer. If the prolapse was less than half of the CAD, the procedure was performed with a purse string suture; otherwise, if the prolapse was more than half of the CAD, the parachute technique was used [14]. In effect, parachute technique, with six short running sutures at 1, 11, 5, 7, 3, and 9 o'clock, allows to attract into the case more amount of prolapsed tissue, and at the same time, it allows to adjust the traction of the tissue in the presence of asymmetric prolapsed so as to be able to perform a tailored resection.…”

“…At the end of the procedure, the suture line must be located at the apex of the hemorrhoidal tissue. The volume and length of the resected specimen were measured after every procedure [14]. The volume was calculated by dipping the specimen in a container filled with water and measuring the quantity of water displacement.…”

“…A recent retrospective multicenter study identified the criticism in the use of the conventional staplers reporting some serious complications as hematoma, bleeding, rectovaginal fistula, sepsis or perineal necrosis, important anastomotic defects, and closing up of rectum with stapler [13]. A new device, TST Starr plus, characterized by a new conformation and a better technology was introduced in order to avoid some of these complications [14]. In effect, the Mega-Windows and Barrier-Free open case offer to the surgeon a better view of the operating field and of the tissue which must be resected.…”

Different characteristics of circular staplers make the difference in anastomotic tensile strength

“…Surgical complications, as anastomotic leak, can be very important leading to prolonged hospital stay, increased morbidity, mortality and medical costs (Mirnezami et al, 2011;Longo, 1998;Boccasanta et al, 2004;Ribaric et al, 2014;Naldini et al, 2014;Naldini, 2011). Although those surgical devices are widespread in different surgical fields, there are a few published papers about their technical features.…”