*6.14.1 The stapled hemorrhoidopexy (SH)*

SH, which was introduced in 1988, is the most widely used method of repositioning the anal cushion [1]. A circular stapler is used to perform a circular excision of the mucosa of the distal rectum and reattach the cut with the stapler, repositioning the prolapsed anal cushions (**Figure 9**).

With circular rectal excision, it is expected that the branch of the superior rectal artery could be cut, and this would result in decreased anal cushion bleeding and the lump would shrink. However, the cutting of the rectal artery cannot be fully realized, because it will depend on the depth of the suture and the location of the artery at the suture level. The research showed that the superior rectal artery was located in the submucosa at 100% at 1 cm above the anorectal ring and 96.6% at 2 cm and 67.1% at 3 cm above the anorectal ring [30]. A study is needed to confirm rectal branch artery cutting in the rectal specimen of stapler hemorrhoidopexy.

A meta-analysis of a randomized controlled trial showed that compared to excisional hemorrhoidectomy, SH provides less pain, a shorter length of stay, and a quicker return to work, but higher long-term recurrence [31, 32]. If the purse-string suture is too deep, it can get into the rectal muscle, which can lead to serious complications. There have been reports of rectovaginal fistulas, pelvic abscesses, and even peritonitis and strictures [2].
