First severe complication described after Longo hemorrhoidopexy

Abstract

Hemorrhoidopexy Longo is a circular staple, used for mucosal hemorrhoidal prolapse, with less postoperative pain, hospital stay and complication rate compared to the classical hemorrhoidectomy (1). However, dehiscences with peritonitis have been described in 0.5% of cases (2), persistent proctalgy in 10% (3), as well as temporary incontinence, skin tags, anal fissures, rectal hematomas, and hemorrhoidal thrombosis (4). The recurrence rate is 5.1% (5).

Massive surgical emphysema after perineal proctosigmoidectomy

“…There are two similar cases of pneumoperitoneum, pneumoretroperitoneum, pneumomediastinum and pneumopericardium after Longo haemorrhoidopexy, one of them also with SCE of the neck 9 10. Furthermore, we found several reports of cervical SCE after perforation including an occult perforation of sigmoid diverticulum7 and a spontaneous rectal perforation 11…”

“…The connection to the mediastinum can be found paraoesophageally. Just above the sternum in the jugulum the gas gets its access to the subcutaneous layers 9. In addition, it is progressing through the neck (along the vessels and subcutaneous) into the retropharyngeal space, all the way up to the face.…”

Prospective Randomized Study on Stapled Anopexy Height and Its Influence on Recurrence for Hemorrhoidal Disease Treatment

“…This concept has been recently shared by other groups [14]. Prospective randomized trials have failed to demonstrate any significant event related to use SA in up to 10% of the patients [15], but case reports of severe complications have appeared in the literature [16][17][18][19][20] Attention to detail is important as is careful consideration purse-string suture [13]. Its success depends on an adequate selection of patients, good preoperative information and a surgical team with broad and proven experience [21].…”