Complications after stapled hemorrhoidectomy: can they be prevented?

Abstract

Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. A review of 1,107 patients treated with SH from twelve Italian coloproctological centers has revealed a 15% (164/1,107) complication rate. Immediate complications (first week) were: severe pain in 5.0% of all patients, bleeding (4.2%), thrombosis (2.3%), urinary retention (1.5%), anastomotic dehiscence (0.5%), fissure (0.2%), perineal intramural hematoma (0.1%), and submucosal abscess (0.1%). Bleeding was treated surgically in 24%, with Foley insertion 15%; and by epinephrine infiltration in 2%; 53% of patients with bleeding received no treatment and 6% needed transfusion. One patient with anastomotic dehiscence needed pelvic drainage and colostomy formation. The most common complication after 1 week was recurrence of hemorrhoids in 2.3% of patients, severe pain (1.7%), stenosis (0.8%), fissure (0.6%), bleeding (0.5%), skin tag (0.5%), thrombosis (0.4%), papillary hypertrophy (0.3%) fecal urency (0.2%), staples problems (0.2%), gas flatus and fecal incontinence (0.2%), intramural abscess, partial dehiscence, mucosal septum and intussusception (each <0.1%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. All hemorrhoidal thromboses were excised. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. Fissure was treated by dilatation in 57%. Most complications (65%) occurred after the surgeon had more than 25 case experiences of stapled hemorrhoidectomy. The most common complication in the first 25 cases of the surgeon's experience was bleeding (48%). Even though SH appears to be promising, we feel that a multicenter randomized study with a long-term follow-up comparing SH and banding is necessary before recommending the procedure. Most complications can be avoided by respecting the rectal wall anatomy in the execution of the procedure.

Stapled Hemorrhoidectomy; Results of a Prospective Clinical Trial in Saudi Arabia

“…In our experience, urinary retention occurred in 16% of cases. The causes of urinary retention are uncertain, but perioperative fluid intake and perioperative pain are the possible precipitating factors [34]. Septic complications including pelvic sepsis after SH have been reported in the literature [35,36] but no such complication occurred in the present study.…”

Stapled hemorrhoidopexy: clinical results for 65 cases

“…In studies related to this, rates between 0.3% and 20% were reported. 12,29 In our series, urinary retention was seen in 2 patients (3%) in whom spinal anesthesia was applied. Drainage was achieved by means of placement of urinary catheter.…”

“…30 In our cases, we considered that antibiotic prophylaxis we applied and no presence of a serious accompanying disease are effective in not seeing infection In the literature, the rate of external hemorrhoidal thrombosis that may be seen in the early or late term after Longo's operation was reported to be around 0.9% and attributed to incompletelyresected hemorrhoidal sinusoids. 6,12,17 Only in one patient from our cases, external stenosis treated by thrombosectomy was seen.…”

“…[2][3][4][5][6] Nonetheless, studies reporting serious complications such as rectal perforation, chronic anal pain, anal stenosis, sepsis, and hematoma after Longo's method are also present. [7][8][9][10][11][12] The aim in our study was to present results of 3 rd and 4 th degree hemorrhoid patients in whom we performed stapled hemorrhoidopexy and to discuss in accompaniment of the literature.…”

Stapled Haemorrhoidopexy for Haemorrhoids: A Review of Our Early Experience

“…Three patients (6%) had urinary retention. Shalaby and Desoky [10] reported a similar rate of 7% in their study, but it is higher than the 1.5% rate reported by Ravo et al [11]. The cause of post-operative urinary retention is uncertain [12].…”