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Reinterventions for Specific Technique-Related Complications of Stapled Haemorrhoidopexy (Sh): a Critical Appraisal
Pierpaolo Sileri*, Vito M. Stolfi, Antonio Chiaravalloti, Achille Lucio Gaspari
Surgery, University of Rome Tor Vergata, Rome, Italy
Introduction: Stapled haemorrhoidopexy (SH) is an attractive alternative to conventional haemorrhoidectomy (CH) because of reduced pain and earlier return to normal activities. However complications rates are as high as 31%. Although some complications are similar to CH, most are specifically technique-related. In this prospective audit we report our experience with the management of some of these complications.
Methods: Data on patients undergoing haemorrhoidectomy at our unit or referred to us are prospectively entered in a database. The onset/duration of specific SH-related complications as well as reinterventions for failed/complicated SH were recorded.
Results: from 1/03 to 10/07, 110 patients underwent SH, while 17 patients were referred after complicated/failed SH. Among SH performed in our group, we observed 21 specific complications in 17 patients (15.5%): urgency (12), tenesmus (5), severe persistent anal pain (2), haemorrhoidal thrombosis (2). Urgency resolved within 4 months in all patients but one in which lasted 8 months.Three patients (2.7%) had tenesmus up to 3 months. One patient with anal pain underwent exploration under anaesthesia (EUA) and retained stapled removal with complete symptoms resolution. The haemorrhoidal thrombosis occurred 4 and 12 days after SH and were treated medically. Six patients developed haemorrhoidal recurrence after 16+/-5 months after SH (range 9-26 months). Four symptomatic patients underwent further CH. Two patients (1,8%) developed symptomatic anorectal stenosis with urgency and frequency and responded to anal dilatation with dilators. Overall reinterventions rate for this group was 5.5%. Among the referred SH-group, 1 patient underwent Hartmann’s procedure because of rectal perforation. The remaining 16 patients experienced at least one of the following: recurrence (6), urgency (6), severe anal pain (4), tenesmus (4), colicky abdominal pain (1), anal fissure (1) and stenosis (1). Recurrences where observed after 16+/-6 months from surgery (range 9-36 months). Four patients underwent CH with regular postoperative recovery. Two patients underwent EUA because of persisting pain after SH (7+/-6 months). Anorectal manometry and ultrasound were performed in both and pelvic MRI in one. In one patients the US showed a small submucosal abscess at the stapled line. The abscess was not seen at the MRI and it was not found at EUA. In both patients, surgical removal of retained staples resolved the pain. One patient underwent anoplasty.
Conclusions: SH presents unusual and challenging complications. Abuses should be minimized and longer-term studies are needed to further clarify its role.
