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Techniques in Coloproctology

, Volume 6, Issue 2, pp 83–88 | Cite as

Complications after stapled hemorrhoidectomy: can they be prevented?

  • B. Ravo
  • A. Amato
  • V. Bianco
  • P. Boccasanta
  • C. Bottini
  • A. Carriero
  • G. Milito
  • G. Dodi
  • D. Mascagni
  • S. Orsini
  • R. Pietroletti
  • V. Ripetti
  • G. B. Tagariello
ORIGINAL ARTICLE

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 1107 patients treated with SH from twelve Italian coloproctological centers has revealed a 15% (164/1107) 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.

Key words Hemorrhoids Circular stapler Complications Anus Anatomy 

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Copyright information

© Springer-Verlag Italia 2002

Authors and Affiliations

  • B. Ravo
    • 1
  • A. Amato
    • 2
  • V. Bianco
    • 3
  • P. Boccasanta
    • 4
  • C. Bottini
    • 5
  • A. Carriero
    • 6
  • G. Milito
    • 7
  • G. Dodi
    • 8
  • D. Mascagni
    • 9
  • S. Orsini
    • 10
  • R. Pietroletti
    • 11
  • V. Ripetti
    • 12
  • G. B. Tagariello
    • 13
  1. 1.Rome American Hospital, Via Emilio Longoni 69, I-00155 Rome, Italy. nadia.fabrini@rahonline.comIT
  2. 2.UCP-Sanremo, ItalyIT
  3. 3.UCP-Cetraro, ItalyIT
  4. 4.UCP-Policlinico, Milan, ItalyIT
  5. 5.Gallerate, Milan, ItalyIT
  6. 6.UCP-Sassuolo-Modena, ItalyIT
  7. 7.Tor Vergata University, Rome, ItalyIT
  8. 8.University of Padua, ItalyIT
  9. 9.La Sapienza University, Rome, ItalyIT
  10. 10.UCP-S.S. Trinità Hospital, Sora (FR), ItalyIT
  11. 11.University of L'Aquila, ItalyIT
  12. 12.UCP-CampusBioMedico, Rome, ItalyIT
  13. 13.Pistoia, ItalyIT

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