Stomach stapling and rectal stapling are modern techniques in the digestive system

Prof. Dr. Ali Ahmed Shafik

Professor of colon and anal surgery, Kasr Al-Aini Faculty of Medicine

President of the Mediterranean Society of Colon and Anus

Recently, the term “stomach stapling” has spread to treat cases of severe obesity after the decline in gastric band surgeries, as a result of weight gain after losing weight.

Rectal stapling has also spread recently, especially in Europe, to deal with cases of chronic constipation. These cases are widespread in large numbers and are diagnosed as irritable bowel syndrome. Rectal stapling began in 1998 by devising a new method to reduce the size of the rectum, which had widened and sagging.

There are cases of obstructed defecation in which the patient complains of the inability to excrete the waste despite feeling it in the rectal area. Evacuation attempts are repeated time after time, some of them succeed and some fail, and the final result is complete inability to excrete, that is, 40-60% of the amount of waste is expelled. It must be excreted in one day. Accordingly, half or less of the amount of waste that must be excreted per day occurs, which causes congestion in the rectum area and then the colon. This leads to colon infection due to the increase in the amount of bacteria, irritation of the mucous membrane lining the colon, swelling of the colon due to the increase in the amount of gases resulting from fermentation bacteria, and then contractions of the colon wall in an attempt by the colon to expel what is inside it. So, failure to empty completely or defecate in a closed manner leads to complications in the colon and abdomen. Sometimes stomach pain results from the distension of the transverse colon near the stomach, which leads to pressure on it and the occurrence of some reflux of stomach acid into the esophagus, causing stomach pain.

In an attempt by the body to adapt to not having a complete defecation, the wall of the rectum expands to accommodate the remaining amount of waste along with the newly excreted amount. As the years pass, the size of the rectum swells and begins to fill the pelvic area, with cysts occurring within the wall to increase the volume of storage.

But why does the rectum lose the ability to expel? Studies and research have proven that there is an imbalance in the dynamics of defecation resulting from a lack of harmony between the pelvic muscles and the anal canal, which leads to the inability of the anal canal to fully open during the defecation process and failure to empty completely. Some patients may resort to using a stream of water or using their finger to dilate to help open the anal canal to expel waste. This leads to an injury to the abdominal mucosa of the anal canal, and some cracks, bleeding, or severe pain occur during the excretion process.

Here comes the role of rectal stapling to treat such cases. Its goal is to reduce or remove the sagging and widening of the rectal wall, returning it to its normal size, and increasing the ability of the rectum to contract and expel what is inside it, because sagging or widening of the rectum weakens the ability to contract and thus weakens the ability to expel.

Secondly, raising the anal canal in which prolapse occurs as a result of chronic constipation, and repairing the anal muscles and the angle between the rectum and the anal canal, which increases in severity with the severity of rectal sagging and is one of the reasons for the closure of the anal canal during the excretion process.