Fig. 2

Proposed mechanisms of mucocele formation after SH—double purse string and single purse string approaches. A Open configuration of the stapler with a double purse string. B Configuration after stapler firing. When a double purse string is used widely placed sutures can lead to a small rectal mucocele that is excluded from the stapled cavity during the stapler firing. C A PSH (partial stapled hemorrhoidopexy) stapler prior to firing. D After firing unresected tissue forms a mucosal bridge. E With a single purse string a loose prolapsing fold of rectal mucosa can be excluded with separation after stapler firing (F)