Complications after stapled hemorrhoidectomy: can they be prevented?

• Published in: Techniques in coloproctology Vol. 6; no. 2; pp. 83 - 88
• Main Authors: Ravo, B, Amato, A, Bianco, V, Boccasanta, P, Bottini, C, Carriero, A, Milito, G, Dodi, G, Mascagni, D, Orsini, S, Pietroletti, R, Ripetti, V, Tagariello, G B
• Format: Journal Article
• Language: English
• Published: Italy Springer Nature B.V 01.09.2002
• Subjects: Adult; Aged; Aged, 80 and over; Clinical Competence; Female; Hemorrhoids - surgery; Humans; Male; Middle Aged; Outcome Assessment (Health Care) - statistics & numerical data; Postoperative Complications; Rectal Diseases - etiology; Rectal Diseases - prevention & control; Rectum - surgery; Risk Factors; Surgical Stapling - adverse effects; Surgical Stapling - statistics & numerical data
• ISSN: 1123-6337; 1128-045X
• DOI: 10.1007/s101510200018

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.