String Technique Research Articles

BS P05 Laparoscopic repair of internal hernia post Roux-en-Y Gastric Bypass: Our tricks and technique

Abstract Background The incidence of internal herniation (IH) post Roux-en-Y gastric bypass (RYGB) is variable across literature (0.5–11%). This may be partially related to the difference in the operative techniques of RYGB. Routine closure of mesenteric and Petersen's defects has shown noticeable decline in the incidence of IH over last few years. Nevertheless, it didn't prevent the development of IH at long-term follow up. Methods We describe a video of a case with a large non-obstructing mesenteric internal hernia post RYGB. A 33 years old female patient presented to our bariatric clinic with recurrent attacks of post-prandial abdominal pain over 6 months. She had RYGB 2.5 years before this presentation, with EWL of 65%. Of note, the mesenteric and Petersen's defects were closed in the original RYGB operation. CT scan showed suspicious findings of internal herniation without obstructing signs. Patient had a laparoscopic exploration which showed a large internal herniation through mesenteric defect containing more than two thirds of bowel length. Closure of the defect was done by a purse string technique using non-absorbable prolene 2/0 stitch after reduction of the bowel. Patient had an uneventful postoperative recovery. She denied any further attacks of abdominal pain at her follow up till 6 months postoperatively. Conclusions Diagnosis of non-obstructing internal herniation post RYGB is very challenging. Low threshold for laparoscopic exploration in suspicious cases of remittent abdominal pain is highly recommended. CT scan can't rule out IH completely due to its intermittent nature. Laparoscopic repair remains the optimal approach, even in the large IH, with favourable outcomes. Appropriate identification of the bowel configuration is the key step in such procedure.

Simultaneous replacement and removal of the peritoneal catheter is effective in patients with refractory tunnel infections sustained by S. aureus.

In tunnel infection (TI) refractory to medical therapy or in case of TI that occurs simultaneously with peritonitis, the removal of the peritoneal catheter has been proposed. This approach requires the interruption of peritoneal dialysis (PD) and the creation of a temporary vascular access. However, simultaneous removal and reinsertion of the PD catheter (SCR) represents another possible therapeutic approach. We analysed the outcome of 20 patients (10 men and 10 women, mean age 65.5 ± 16.3years) treated by CAPD for a mean period of 24.3 ± 14.2months who underwent to SCR for the treatment of TI unresponsive to medical therapy or TI that occurred simultaneously with peritonitis at Fondazione Ca' Granda Ospedale Maggiore Policlinico. All the patients restarted CAPD exchanges within 24h from catheter placement. SCR was successful in 80% (16/20) of the cases. In particular, SCR was effective in 100% (11/11) of the TI with or without associated peritonitis sustained by S. aureus. However, SCR failed in 57% (4/7) of TI associated with relapsing peritonitis and in one patient with TI secondary to Enterobacter. No early mechanical complications (within 3months after SCR) occurred when CAPD was restarted. SCR of the PD catheter through double-purse string technique represents an effective treatment for TI without or with simultaneously peritonitis sustained by S. aureus avoiding the patient the need for temporary hemodialysis and second surgical procedure. However, SCR could be contraindicated in case of relapsing peritonitis.

Closed-wound negative pressure therapy dressing after loop ostomy closure: a retrospective comparative study

Closed-wound negative pressure wound therapy (NPWT) dressings were recently introduced with the purpose to reduce incisional surgical site infections (iSSI) in high-risk wounds. The aim of this study was to compare iSSI rates in patients after ostomy closure with and without additional application of a closed-wound NPWT dressing. Single-center retrospective analysis of consecutive patients undergoing ileo- or colostomy closure over an 8-year period (January 2013—January 2021). Intradermal non-purse string technique with absorbable sutures were used in all patients. Since November 2018, all patients (study group) received a NPWT device for a maximum of 5 days postoperatively (PICO, SMITH AND NEPHEW). Primary outcome was iSSI rate within 30 days of surgery. SSI was defined in accordance with the Center of Disease Control (CDC) classification and included superficial and deep incisional SSI. Data was retrieved from the institutional enhanced recovery after surgery (ERAS) database, with standardized complication assessment by trained abstractors. In total, 85 patients (25%) in the study group were comparable with 252 (75%) patients in the control group regarding demographics (age, gender, body mass index, ASA score), ostomy type and anastomotic technique (all p > 0.05), but not wound contamination class (class III: 5% vs 0%, p < 0.001). Median time to NPWT removal was 4 (IQR 3–5) days. Incisional SSI were observed in 4 patients (4.7%) in the study group and in 27 patients (10.7%) in the control group (p = 0.097). These preliminary results suggest a potential benefit of systematic application of the NPWT device after loop ostomy closure. A randomized controlled study is needed.

MO694: Analysis of Mechanical Complications in Urgent-Start Peritoneal Dialysis

Abstract BACKGROUND AND AIMS Peritoneal dialysis (PD) is an excellent, but underutilized dialysis technique. Thus, its implementation might depend on the chance to offer this modality of treatment to late referral patients. This approach has been recently named ‘urgent-start peritoneal dialysis’ (UPD). The major barrier to this practice is represented by the belief that peritoneal exchanges can be safely started at least 2 weeks after catheter insertion, due to the concern of early mechanical complications. The study investigated the efficacy and safety of an UPD approach in our PD program. METHOD Between 1 January 2009 and 31 December 2019 all prevalent patients needing UPD at our institution were included in the study. During this period, 242 peritoneal catheters were inserted in 222 patients (Table 1). One hundred forty-eight catheters were positioned semi-surgically, while 94 were inserted surgically. In all patients, an anti-leakage/dislocation suture was made. PD was started within 24 h from catheter placement and peritoneal exchange scheme characterized by progressively increasing volume was used; early and late mechanical complications were also analysed. Finally, all the causes of PD technique and catheter failure were reported. RESULTS The early incidence of leakages, catheter dislocations, omental wrappings, bleeding, peritonitis and exit-site infections was 11/242 (4.5%), 5/242 (2%), 3/242 (1.2%), 2/242 (0.8%), 6/242 (2.5%) and 4/242 (1.6%), respectively (Table 2). No bowel perforations were observed. The long-term leakage rate and catheter dislocation were 0.016 and 0.019 episodes/patient-year, respectively (Table 3). The survival of the catheter at 3, 6, 12, 24, 36 and 48 months was 93.6, 91.2, 84.8, 77.4, 65.5 and 59.3%, respectively (Fig. 1). The technique survival at 3, 6, 12, 24, 36 and 48 months was 97.2, 94.9, 87.6, 78.9, 66.6 and 60.0%, respectively (Fig. 2). The main cause of PD dropout was represented by infectious complications (nearly 40%) and mechanical complications (17.5%) leading to catheter failure (Fig. 3). No significant difference in the first catheter survival among the semi-surgical and the surgical arm was observed (HR 0.88 [CI 0.54–1.45], P = 0.62 [Fig. 4]). CONCLUSION A tight seal between deep cuff and surrounding tissue (double-purse string technique) with a low-volume exchange scheme allows starting UPD soon after catheter insertion minimizing mechanical complications. In patients without previous abdominal interventions semi-surgical technique is as effective as the surgical procedure in preventing early mechanical complications.

Effects of Attentional Focus on Motor Performance and Physiology in a Slow-Motion Violin Bow-Control Task: Evidence for the Constrained Action Hypothesis in Bowed String Technique.

The constrained action hypothesis states that focusing attention on action outcomes rather than body movement improves motor performance. Dexterity of motor control is key to successful music performance, making this a highly relevant topic to music education. We investigated effects of focus of attention (FOA) on motor skill performance and EMG muscle activity in a violin bowing task among experienced and novice upper strings players. Following a pedagogically informed exercise, participants attempted to produce single oscillations of the string at a time under three FOA: internal (on arm movement), external (on sound produced), and somatic (on string resistance). Experienced players’ number of bow slips was significantly reduced under somatic focus relative to internal, although number of successful oscillations was not affected. Triceps electromyographic activity was also significantly lower in somatic compared to internal foci for both expertise groups, consistent with physiological understandings of FOA effects. Participants’ reported thoughts during the experiment provided insight into whether aspects of constrained action may be evident in performers’ conscious thinking. These results provide novel support for the constrained action hypothesis in violin bow control, suggesting a somatic FOA as a promising performance-enhancing strategy for bowed string technique.

A Comparative Study of Pediatric Inguinal Hernia Repair by Open Technique versus Laparoscopic Repair

Background: Herniotomy / open surgery has been the time honoured treatment for paediatric inguinal hernia. The improvement of paediatric Laparoscopic hernia and increased experience with Laparoscopic technique become an important skill. Laparoscopic repair of inguinal hernias in children is adopted too quickly, cost effective, cosmetically, less invasive, more feasible and less painful. This procedure is that, it could allow contralateral hernia detection and repair in same setting. Aims and objectives: In our study we aimed to compare between the outcome of inguinal hernia repair in two study group open hernia repair and Laparoscopic hernia repair by Z suture or purse string technique and study to the early and late complication. Materials and methods: the current prospective study carried out in Department of General Surgery, SVBP Hospital Meerut which included 40 patients duration of period from September 2018 to September 2019. Among them, 20 patients in group 1 were repaired by Open procedure and another 20 patients in group 2 were repaired by Laparoscopic procedure. Results: The study included 40 patients. The mean time of operation in Laparoscopic repair (41.50 minute) is slightly shorter than that of open repair (47.50 minute) technique. Postoperative pain was much less in LH group then open hernia group. Hospital stay in LH (1.55 days) and in OH (2.20 days). Oral ships were allowed and well tolerated as early in LH (7.3 hrs) and in OH (10.90 hrs), this was statistically significant. Patients financial satisfaction was lower in group 2than in group 1 repair. Conclusion: The data from study confirmed that the results of Laparoscopic technique has advantage of reduced postoperative pain, diagnosis of CPPV with its management in the same sitting, rapid return to everyday activities, better cosmetic results, cost effective, more feasible and less painful.

Four Quadrant-Embedded Purse-String Closure for Defects of Benign Skin Tumors Post Circular Excision.

Skin wounds after elliptical removal of benign tumors, are conventially sutured linearly for closure and often result in longer and undesirable scars. We aimed to evaluate the efficiency of four quadrant embedded intradermal purse-string suture closure technique for round defects in order to obtain satisfactory cosmetic outcomes and limited scar. We analysed the features of 143 patients for whom a total of 208 four quadrant embedded purse string sutures were used to completely close their postoperative surgical defects. The location and histopathological types of the tumors removed were noted. Tumors were located in the cervicofacial region, thoracic region, back, lower and upper extremities. The patient and observer scar assessment scale (POSAS) questionairre was utilized to evaluate objective results of the ultimate scar. The defects of the lesions after excision were closed using intradermal four quadrant buried purse-string suture. The wounds showed good final healing without obvious adverse events postoperatively. Infection occurred only in three patients. The final cosmetic appearance of the healed wounds was satisfying as POSAS scores were 17.74 for patient scar assesment scale (PSAS) and 15.3 for observer scar assessment scale (OSAS). Four quadrant embedded purse string technique is a simple and useful method to close skin defects after circular resection of lesions. It provides minimal scarring and remarkable patient satisfaction.

Double Purse String Closure Technique for Minimizing Post-Operative Widening of Periareolar Augmentation Mastopexy: A Comparative Study

Objectives: For management of mild degree breast ptosisperiareolar mastopexy had been commonly used. Since Benelli1990 had confined the scar to the areola in his round-blocktechnique, several authors has adopted this technique. Whethermastopexy had been done with or without augmentation, theproblems of breast shape, areolar irregularities,and stretch ofthe areola had been annoying to both patients and surgeons.These problems also represent a major challenge to thistechnique. In this paper purse string closure was used in twoconsecutive different layers one in dermal de-epithelized layerand another in the deep dermis of the skin. The aim is tominimize widening of scars of peri-areolar incision andimprove its long term appearance.Patients and Methods: 50 cases underwent mastopexywith breast augmentation. Cases were divided into two groups:Group A: Underwent closure by single purse string layer andGroup B: Two consecutive purse string closure. The secondconcentric row was applied to the deep dermal plane of thenormal non de-epthelialized skin similar to the classical pursestring closure described previously. Both subjective andobjective evaluation were done. Surgery was done by singlesurgeon and two surgeons not involved in research evaluatedthe post-operative photos. Follow-up was done at 3, 6 monthand at 1 year post-operative.Results: Group B patients showed superior results asregarding breast shape, contour, projection, superior fullness,periareolar scar shape, regularity, areola width and position.These results were followed-up for one year.Conclusion: Decreasing the tension of the periareolar sutureby applying double purse string technique in two differentplanes improved long term results of periareolar scar in orderto avoid widening, irregularities and hypertrophic scarring.

Homogeneous Distribution of Polymerizable Coumarin Dyes for Active Few Mode POF.

For most kinds of active polymer optical fibers, a homogeneous distribution of dye molecules over the entire fiber length and cross section is required. In this study, chemical bonding of dyes to poly(methyl methacrylate) (PMMA) by copolymerization is achieved within the polymerization process instead of dissolving the dyes in the monomers. In combination with an improved fabrication mechanism, this leads to homogeneous dye distribution within the preforms. A method for proving the integration of the dyes into the polymer chains has been developed using high-performance liquid chromatography (HPLC) and size exclusion chromatography (SEC). Prestructured core-cladding preforms with dye-doped poly(cylohexyl methacrylate-co-methyl methacrylate)-core have been prepared with the Teflon string technique and were heat-drawn to few mode fibers.

Resorbable Magnesium Scaffold in Coronary Bifurcations - Report of in Vitro Experiments.

The aim of this work is to evaluate in an in vitro setting the behavior of resorbable magnesium scaffolds (RMS) in bifurcations. As coronary bifurcations represent an important portion of all PCIs, it is crucial to understand whether RMS is applicable in these complex lesions. Performance of RMS was evaluated with focus on bifurcations. In bifurcations RMS was tested for (1) main branch stenting with side branch opening and proximal optimization; for (2) main branch stenting with final kissing and proximal optimization; for (3) T-and-protrusion technique; for (4) string technique, which is a minimalistic version of conventional culotte technique. All tests were performed using 3.50 × 25 mm RMS. Results were evaluated by fluoroscopy, optical coherence tomography (OCT) and micro-computed tomography (μCT), for scaffold conformability, strut apposition, structural deformation and strut fracture. All planned procedural steps were performed successfully with good result according to fluoroscopy. By OCT the overall malapposition rate in bifurcation cases was 4.3%, occurring predominantly in the carinal area. No malapposition was seen at the proximal main branch confirming proper conformability of RMS. μCT analysis has shown that final kissing dilation resulted in fully stretched struts in cases, where performed with 3.5 and 3.0 mm balloons. In one case a broken connector (T-and-protrusion) and in another case, a broken strut (String technique) were identified. RMS can structurally cope with bifurcations. Still, for cases and techniques where overexpansion beyond the recommended limit is needed, RMS might not be the proper device due to risk of strut fracture.

Implication of an Objectivist-Constructivist Blended Approach on Students’ Achievement and Satisfaction in University-Level Beginner String Technique Classes

&lt;p&gt;&lt;em&gt;Teaching music generally implicates multidimensional process whereby an assortment of approaches should be incorporated in order to provide the right and proper ambience for teaching and learning process. The need to explore and further understand the complexity in teaching beginner string technique class instigates the study which explore the implication of an objectivist-constructivist blended approach for teaching beginners string technique class. This paper explores the impact of blended-approach teaching on students’ achievement and satisfaction in Malaysian university-level beginner string technique classes. Using a quasi-experimental non-equivalent control group post-test only design, students (N = 40) from two local public universities were assigned to one of two treatment condition: experimental group, where students were presented with blended approach instructional material, and control group, where students were presented with conventional instructional material. Students completed the course of 14 weeks. The implementation results revealed that the proposed blended approach contributes to meaningful and efficient learning.&lt;/em&gt;&lt;/p&gt;

Surgical Repair of umbilical hernia in children

Background: Elective repair of an umbilical hernia is one of the most common surgical operations performed by pediatric surgeons, although most of them resolve spontaneously during the first 3 years of life. The exact technique and steps involved in the repair differ widely among pediatric surgeons. Many pediatric surgeons prefer the transverse interrupted suture technique in rectus sheath closure than the purse string or continuous technique as it isolates the tension to each individual stitch, ensures correct suture placement and precise coaptation of edges. It is less likely to devascularize the incision margin. Interrupted sutures also have the advantage that they can be removed individually if infection or haematoma formed, while the purse string suture or the continuous closure has the disadvantage of being a single suture line holding the fascia together and most of wound dehiscence occurs because sutures cut through the fascia. In this study we give a chance to assess the efficacy of the purse string technique. Objective: The aim of our study is to compare between umbilical hernia repair of rectus sheath with closure by interrupted sutures and purse string technique regarding operative time, intra operative complications (bleeding, intestinal injury), and post-operative complications (edema, hematoma formation, seroma formation, cosmetic appearance & recurrence). Materials & Methods: A total of 30 umbilical hernias in children (17 females and 13 males) were operated in Ain Shams University hospital and El Galaa teaching hospital from September 2017 till May 2018. Results: In this prospective study, 30 cases of umbilical hernia in children aging from two years till the age of ten years including 17 female and 13 male with a ratio of 1.3: 1 were randomly selected from the outpatient clinic of Ain Shams University hospital and Al Galaa teaching hospital were divided into two equal groups, group A underwent the repair of the rectal sheath with purse string suture technique while group B underwent the repair with transverse interrupted suture technique. Conclusion: Conclusively, there are no significant differences between both techniques regarding the intra operative complications and post-operative complications in short term follow up; however, transverse interrupted suture technique appears to consume more time than the purse string technique.

New application of purse string suture in skin cancer surgery.

Closure of large wounds may require full-thickness skin grafts, but their use is burdened by donor tissue availability and morbidity; the use of the purse string technique is an elegant way to overcome this problem. The study highlights the gain in terms of graft donor site morbidity and oncological radicality. The study included a group of 47 patients who underwent surgical excision for skin cancer and whose wounds were covered using a purse string suture and a skin graft. Radius of the defect left was measured after the lesion's excision and after the purse string suture. Thereafter, the difference between the initial defect area and the area after purse string suture was calculated. Initial defects ranged from 3.85 to 61.5 cm2 . After skin graft, the purse string suture ranged between 2.2 and 40 cm2 (mean area = 14 cm2 ). Gained area before the graft measured from 1.3 to 21.5 cm2 (mean gained area = 7.1 cm2 ). Average reduction was 33%. The technique allows a reduction of the size of the area to be grafted and the skin graft donor area, thus increasing the possibility of the feasibility of full-thickness grafts. In addition, it allows an optimal observation both of the area of tumour excision and margins during follow-up controls.

A Modified String Technique for Atraumatic Ring Removal

BackgroundWe describe a modified string technique for ring removal from an edematous finger, a critical step in the initial treatment of a patient with upper-extremity trauma. TechniqueThis technique involves multiple sutures looped around the ring to provide differential tension on the ring as it is advanced distally over a lubricated digit. With the use of an assistant, the ring can be advanced in caterpillar fashion without sliding back proximal when the direct pressure is released as a result of edema. ConclusionsThis multisuture technique adds to the armamentarium of methods for ring removal in the setting of upper-extremity trauma without reverting to alternate techniques for cutting or shattering the ring.

Mitral valve repair with the ring noose string technique and an annuloplasty ring

Mitral valve repair with the ring noose string technique and an annuloplasty ring

A novel magnetic device for laparoscopic cholangiojejunostomy

BackgroundLaparoscopic cholangiojejunostomy (LCJ) with hand-sewn technique is technically difficult and requires a long time to master. The purpose of this study was to assess the feasibility of LCJ using a novel magnetic compression device (MCD) in dogs. MethodsThe concept of the purse–string technique of the circular stapler was used to design a novel MCD for LCJ. To test the feasibility of this MCD in a more clinically relevant situation, four dogs were subjected to bile duct ligation. When the diameter of their bile ducts reached 10 mm, LCJ using MCD was performed. The anastomotic time and expelling time of the magnets were assessed. ResultsIn the clinically relevant model of bile duct obstruction in dogs, LCJ created with this MCD yielded patent anastomoses. The LCJ procedure using this novel MCD was simple, and the mean anastomotic time was 12.9 ± 1.73 min. All animals recovered smoothly after the operation without complications. All magnets spontaneously passed through the rectum in 14.5 ± 2.08 d after LCJ. ConclusionsLCJ in dogs using this novel MCD is feasible.

Reversed single string technique for coronary bifurcation stenting-First report of case demonstrations in vitro.

This work reports the concept and the practical feasibility of Reversed Single String bifurcation stenting technique by demonstrating three in vitro cases. Provisional T stenting is the most used interventional technique to treat coronary bifurcation lesions. However, after main branch (MB) stenting, treatment of the side branch (SB) may become indicated to provide a good final result. Currently applied methods all have their structural limitations with respect to wall coverage, multiple strut layers, poor apposition rate. We reasoned that reversing the Single String technique principle could be used as a bail out after inadequate provisional T stenting. We simulated in three silicone bifurcation phantoms a scenario whereby stenting the SB becomes indicated after provisional T stenting. Thereafter, as first step of Reversed Single String, a stent was deployed into the SB ostium with one single protruding stent-cell into the MB. After wiring that stent-cell and positioning MB balloon across it, final kissing balloon dilation was performed. Results of the in vitro Reversed Single String cases were evaluated by X-ray angiography, optical frequency domain imaging, and 3-Dimensional (3D) reconstruction (OFDI). Each case was successfully performed and completed. In the bifurcation area, perfect apposition was documented in over 81% of the struts. Malapposition remained below 4% of struts in each case. 3D OFDI reconstruction did not reveal any strut fracture. This report suggests that Reversed Single String technique might offer a potential bail out solution for provisional T-stenting cases, when treatment of the SB becomes indicated. © 2017 Wiley Periodicals, Inc.

Posterior suture annuloplasty for functional tricuspid regurgitation

Functional tricuspid regurgitation (TR) is primarily caused by enlargement of the tricuspid annulus due to right ventricular dilation, frequently secondary to left sided valvular disease. Early techniques for the treatment of functional TR were introduced by Jerome Kay in 1965 and Norberto DeVega in 1972. Modified suture annuloplasty is a modification of DeVega's semicircular purse string technique, however, it is based on Kay's principle of obliteration of the posterior segment of the annulus only. While ring annuloplasty is the procedure of choice for severe functional TR, posterior suture annuloplasty is a technically simpler option for patients with moderate functional TR.

0255: Reversed Single String technique for coronary bifurcation stenting– first report in vitro case demonstrations

This work reports the concept and the practical feasibility of Reversed Single String bifurcation stenting technique by demonstrating three in vitro cases. Provisional T stenting is the most used interventional technique to treat coronary bifurcation lesions. However, after main branch (MB) stenting, treatment of the side branch (SM) becomes often indicated to provide with good final result. Currently applied methods all have their morphologic or structural limitations with respect to wall coverage, multiple strut layers, apposition rate. We sought that reversing the Single String technique principle may be used as a bail out for such clinical situations. This proof-of-concept report describes and evaluates the procedure. We simulated in three silicone bifurcation phantoms the scenario when stenting the SB becomes indicated after deployment of the MB stent and performing kissing balloon dilatation. Thereafter, as first step of Reversed Single String, a stent was positioned and deployed into the SB ostium with one single protruding stent-cell into the MB. After wiring that stent-cell and positioning MB balloon across it, final kissing balloon dilation was performed. Result of the three in vitro Reversed Single String cases was evaluated by X-ray and by optical frequency domain imaging and 3D reconstruction (OFDI). Each case was performed successfully. In the bifurcation area perfect apposition was documented in over 81% of the struts. Malapposition occurred most frequently in area of neo-carina, but still remained below 4% of struts for each case. 3D OFDI reconstruction did not reveal any strut fracture. This report suggests that Reversed Single String technique might offer a potential bail out solution for provisional T-stenting cases, when treatment of the SB becomes indicated. Abstract 0255 – Figure

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

The aim of the study was to assess the results of the stapled transanal procedure in the treatment of hemorrhoidal prolapse in terms of postoperative complications and recurrence rate using a new dedicated device, TST Starr plus. Patients affected by III-IV degree hemorrhoidal prolapsed that underwent stapled transanal resection with the TST Starr plus were included in the present study. Results of the procedure with perioperative complications, postoperative complications, and recurrence rate were reported. From November 2012 to October 2014, 52 patients (19 females) were enrolled in the study. The main symptoms were prolapse (100 %) and bleeding (28.8 %). Transanal rectal resection was performed with parachute technique in 24 patients (46.2 %) and purse string technique in 23 patients (53.8 %). A mild hematoma at the suture line occurred in one patient (1.9 %). Postoperative bleeding was reported in three patients (5.7 %), in one of which, reoperation was necessary (1.9 %). Tenesmus occurred in one patient (1.9 %), and it was resolved with medical therapy. Urgency was reported in nine patients (17.1 %) at 7 days after surgery. Of these, three patients (5.7 %) complained urgency at the median follow-up of 14.5 months. Reoperation was performed in one patient (1.9 %) for chronic anal pain for rigid suture fixed on the deep plans. Occasional bleeding was reported in four patients (7.7 %). No recurrence of prolapse was reported at a median of 14.5 months after surgery, even if one patient (1.9 %) had a partial recurrent prolapse of a downstaged single pile. TST Starr plus seems to be safe and effective for a tailored transanal stapled surgery for the treatment of III-IV degree hemorrhoidal prolapse. The new conformation and innovative technology of the stapler seems to reduce some postoperative complications and recurrence rate.