The stapled hemorrhoidopexy syndrome: a new clinical entity?

Efthimiadis, Christoforos; Kosmidis, Chr.; Grigoriou, Marios; Anthimidis, Georgios; Vasiliadou, Kalliopi; Baka, Sofia; Gerasimidou, Domniki; Basdanis, G.

doi:10.1007/s10151-011-0741-1

Cited by 6 publications

(2 citation statements)

References 9 publications

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“…The cause of soiling and urgency after stapled hemorrhoidopexy is multifactorial, and possibly a result of the dynamics of the anastomosis. Symptoms after some endoanal stapled surgeries, including cramping abdominal pain, fecal urgency, difficulty in defecation, and even incontinence, have been sufficiently specific as to be labeled by some a “stapled hemorrhoidopexy syndrome 25 ” or a “postPPH syndrome. 26 ” The pathogenesis of this cluster of symptoms is complex and most likely reflects excessive inflammatory responses to the staples combined with a reduced effective neorectal reservoir.…”

Section: Discussionmentioning

confidence: 99%

Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial

Lin

Shao

et al. 2019

Diseases of the Colon &Amp; Rectum

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BACKGROUND:Long-term outcomes and efficacy of partial stapled hemorrhoidopexy are not known.OBJECTIVE:The purpose of this study was to compare the long-term clinical efficacy and safety of partial stapled hemorrhoidopexy with circumferential stapled hemorrhoidopexy.DESIGN:This was a parallel group, randomized, noninferiority clinical trial.SETTINGS:The study was conducted at a single academic center.PATIENTS:Patients with grade III/IV hemorrhoids between August 2011 and November 2013 were included.INTERVENTIONS:Three hundred patients were randomly assigned to undergo either partial stapled hemorrhoidopexy (group 1, n = 150) or circumferential stapled hemorrhoidopexy (group 2, n = 150).MAIN OUTCOME MEASURES:The primary outcome was the rate of recurrent prolapse at a median follow-up period of 5 years with a predefined noninferiority margin of 3.75%. Secondary outcomes included incidence and severity of postoperative pain, fecal urgency, anal continence, and the frequency of specific complications, including anorectal stenosis and rectovaginal fistula.RESULTS:The visual analog scores in group 1 were less than those in group 2 (p < 0.001). Fewer patients in group 1 experienced postoperative urgency compared with those in group 2 (p = 0.001). Anal continence significantly worsened after both procedures, but the difference between preoperative and postoperative continence scores was higher for group 2 than for group 1. Postoperative rectal stenosis did not develop in patients in group 1, although it occurred in 8 patients (5%) in group 2 (p = 0.004). The 5-year cumulative recurrence rate between group 1 (9% (95% CI, 4%–13%)) and group 2 (12% (95% CI, 7%–17%)) did not differ significantly (p = 0.137), and the difference was within the noninferiority margin (absolute difference, –3.33% (95% CI, –10.00% to 3.55%)).LIMITATIONS:The study was limited because it was a single-center trial.CONCLUSIONS:Partial stapled hemorrhoidopexy is noninferior to circumferential stapled hemorrhoidopexy for patients with grade III to IV hemorrhoids at a median follow-up period of 5 years. However, partial stapled hemorrhoidopexy was associated with reduced postoperative pain and urgency, better postoperative anal continence, and minimal risk of rectal stenosis. See Video Abstract at http://links.lww.com/DCR/A790.Trial registration (chictr.org) identifier is chiCTR-trc-11001506.

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Section: Discussionmentioning

confidence: 99%

Partial Stapled Hemorrhoidopexy Versus Circumferential Stapled Hemorrhoidopexy for Grade III to IV Prolapsing Hemorrhoids: A Randomized, Noninferiority Trial

Lin

Shao

et al. 2019

Diseases of the Colon &Amp; Rectum

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“…After stapled hemorrhoidopexy, a relevant percentage of patients develops a syndrome consisting of urgency for defecation, feeling of foreign body, and cramp-like anal pain of variant amplitude [67,68].…”

Section: Complicationsmentioning

confidence: 99%

Clinical Outcome Following Hemorrhoid Surgery: a Narrative Review

Picchio¹,

Greco²,

Filippo

et al. 2014

Indian J Surg

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Surgical therapy guaranties satisfactory results, which are significantly better than those obtained with conservative therapies, especially for Grade III and IV hemorrhoids. In this review, we present and discuss the results of the most diffuse surgical techniques for hemorrhoids. Traditional surgery for hemorrhoids aims to remove the hemorrhoids, with closure (Fergusson's technique) or without closure (Milligan-Morgan procedure) of the ensuing defect. This traditional approach is effective, but causes a significant postoperative pain because of wide external wounds in the innervated perianal skin. Stapled hemorrhoidopexy, proposed by Longo, has gained a vast acceptance because of less postoperative pain and faster return to normal activities. In the recent literature, a significant incidence of recurrence after stapled hemorrhoidopexy was reported, when compared with conventional hemorrhoidectomy. Double stapler hemorrhoidopexy may be an alternative to simple stapled hemorrhoidopexy to reduce the recurrence in advanced hemorrhoidal prolapse. Transanal hemorrhoidal deartertialization was showed to be as effective as stapled hemorrhoidopexy in terms of treatment success, complications, and incidence recurrence. However, further high-quality trials are recommended to assess the efficacy and safety of this technique.

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