What it is

What is Stapled Hemorrhoidopexy?

Stapled Hemorrhoidopexy, also known as Procedure for Prolapse and Hemorrhoids (PPH), is a surgical procedure designed to treat abnormally enlarged or prolapsed internal hemorrhoids (Grade III and IV). Unlike a traditional hemorrhoidectomy which excises the hemorrhoidal tissue, this technique involves the removal of a circumferential ring of mucosa and submucosa from the upper anal canal using a specialized circular stapling device. This procedure has two main effects: it pulls the prolapsed hemorrhoidal cushions back up into their normal anatomical position (a 'pexy' or lifting effect) and it interrupts the terminal arterial blood flow to the hemorrhoids, causing them to shrink. Because the staple line is located in the upper rectum, an area with less sensitive nerve endings, the procedure is generally associated with significantly less postoperative pain than excisional hemorrhoidectomy.

Am I a candidate?

Who is a Good Candidate for PPH?

PPH is an ideal treatment for patients with symptomatic Grade III and IV internal hemorrhoids, particularly those with circumferential prolapse. It is a suitable option for patients who desire a less painful alternative to traditional excisional hemorrhoidectomy and a quicker return to normal activities. It is not designed to treat external hemorrhoids or large, symptomatic skin tags. Patients with very large, fibrotic internal hemorrhoids may also not be ideal candidates.

How it's done

1You're asleep or numbed from the waist down — general or spinal anesthesia in the operating room.

2A circular stapling device removes a ring of loose, stretched lining from the upper anal canal — above the nerve-rich zone, which is why it hurts less than excision.

3The staple line lifts the prolapsed hemorrhoid cushions back into their normal position and reduces the blood flow feeding them, so they shrink.

4Nothing is cut away at the sensitive skin outside, so there are no external wounds to heal. It does not treat external hemorrhoids or skin tags.

5Home the same day for most people.

What to expect

Same day

Home the same day. The work is all internal — no external wounds or packing.

First days

A feeling of fullness, pressure, or an urge to go is common; the raw pain typical of excisional surgery is mostly absent. Sitz baths and simple pain relievers usually cover it.

First 1–2 weeks

Soft stools matter — fiber, fluids, stool softeners. Most people get back to normal, non-strenuous activity sooner than they would after excisional surgery.

Long term

The honest trade-off: in the largest randomized trial, about 1 in 3 patients (32%) reported their hemorrhoids had returned within one year after stapled surgery, versus about 1 in 7 (14%) after excisional surgery — and by two years it was about 2 in 5 (42%) versus 1 in 4 (25%). Less pain now, a higher chance of a repeat procedure later.

Risks & considerations

What are the Risks?

While generally safe, stapled hemorrhoidopexy has a unique set of potential risks and complications. These include:

Pain: While typically less than excisional hemorrhoidectomy, some patients may experience significant rectal pain or a feeling of urgency, particularly if the staple line is placed too low in the anal canal.
Bleeding: Bleeding can occur from the staple line, either immediately after the procedure or in a delayed fashion.
Staple Line Complications: The staple line can, in rare cases, dehisce (come apart) or lead to a stricture (narrowing) of the rectum over time.
Urinary Retention: Difficulty urinating is a common short-term side effect after anorectal surgery.
Infection: Though very rare, life-threatening pelvic sepsis has been reported.
Recurrence: The rate of hemorrhoid recurrence and need for subsequent procedures may be slightly higher than with traditional hemorrhoidectomy.