Check, whether the hemorrhoids can be reduced, and if so, intraoperatively verify the indication for stapled hemorrhoidopexy. Carefully dilate the anal sphincter.
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Verifying the indication and dilating the anal sphincter
![Verifying the indication and dilating the anal sphincter]()
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Purse string suture
![Purse string suture]()
With the PPH set (Procedure for Prolapse and Hemorrhoids), place a circular, submucous purse string suture just superior to the hemorrhoidal base, markedly proximal to the dentate line and sparing the muscles.
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Inserting the stapler
![Inserting the stapler]()
With the stapler fully opened, close and tie the purse string suture below the anvil. Digitally examine the anal canal and stapler position.
