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Complications and reoperations in stapled anopexy: learning by doing

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Although stapled anopexy for second and third degree hemorrhoids has been widely used since 1998, there are limited long-term data available. We performed an analysis of a prospectively accrued data set of all patients undergoing stapled anopexy in our practice from 1998 through August 2003. Patients were specifically assessed for early and late complications and long-term reoperation rates for anorectal pathology. We performed stapled anopexy in 654 patients (296 females) during the study period. Mean operation time was 21 min (5–70 min), and the postoperative stay was 3.6 days (1–13 days). Early postoperative complications: urinary retention, 42 patients (6.4%); fecal impaction, 18 (2.8%); postoperative hemorrhage, 26 (4.0%); thrombosed external hemorrhoid, four (0.6%); and fistula/abscess, nine (1.4%). Late postoperative complications: anastomotic dehiscence, 21 patients (3.2%); persistence of prolapse in three (0.5%); submucosal anastomotic cysts in four (0.6%); thrombosed external hemorrhoid in two (0.3%); skin tags in ten (1.5%); fissure in six (0.9%); proctitis in two (0.3%); and fecal incontinence in ten (1.5%). Reoperation was required in 50 patients (7.6%). Reoperation for complications within 30 days occurred in 42 patients (6.4%) for the following reasons: bleeding (23), dehiscence (five), thrombosed external hemorrhoid (three), fecal retention (two), fistula (three), fissure (five), and anal papilla (one). Reoperation for anorectal pathology after 30 days was required in 54 patients (8.3%) and was performed for the following: dehiscence/reprolapse (17), stenosis (two), submucous cyst (two), fistula (four), fissure (six), anal papilla (four), skin tags (five), persistent anal itching (five), and miscellaneous (seven). These data represent the largest series of patients with long-term follow-up following stapled anopexy and confirm that the operation is safe in experienced hands using appropriate patient selection. The early complication rate is low and similar to rates reported for excisional hemorrhoidectomy. Importantly, the procedure is associated with a low 3.4% rate of reoperation for persistence or recurrence of hemorrhoidal prolapse with good patient selection.

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References

  1. Corman ML, Graviè J-F, Hager T, Loudon MA, Mascagni D, Nyström P-O, Seow-Choen F, Abcarian H, Marcello P, Weiss E, Longo A (2003) Stapled haemorrhoidopexy: a consensus position paper by an international working party-indications, contra-indications and technique. Colorectal Dis 5:304–310

    Article  CAS  PubMed  Google Scholar 

  2. Koblandin SN, Schalkow JL (1981) Eine neue Methode zur Behandlung von Hämorrhoiden mit Hilfe eines Zirkularstaplers. Wiss Arch Zelinograder Med Inst (Kasachst):27–28

    Google Scholar 

  3. Longo A (1998) Treatment of hemorrhoidal disease by reduction of mucosa and hemorrhoidal prolapse with a circular suturing device: a new procedure. Proceedings of the 6th World Congress of Endoscopic Surgery, Monduzzi Editore, Bologna, pp 777–784

    Google Scholar 

  4. Milligan ETC, Morgan CN, Jones LE, Officer R (1937) Surgical anatomy of the anal canal and the operative treatment of haemorrhoids. Lancet 11:1119–1124

    Article  Google Scholar 

  5. Fansler WA, Anderson JK (1933) A plastic operation for certain types of haemorrhoids. JAMA 101:1064

    Google Scholar 

  6. Parks AG (1956) The surgical treatment of haemorrhoids. Br J Surg 43:337

    CAS  PubMed  Google Scholar 

  7. Ho YH, Cheong WK, Tsang C, Ho J, Eu KW, Tang CL, Seow-Choen F (2000) Stapled hemorrhoidectomy-cost and effectiveness. Randomized, controlled trial including incontinence scoring, anorectal manometry and endoanal ultrasound assessment at up to three months. Dis Colon Rectum 43:1666–1675

    PubMed  Google Scholar 

  8. Bikhchandani J, Agarwal PN, Kant R, Malik VK (2005) Randomized controlled trial to compare the early and mid-term results of stapled vs. open hemorrhoidectomy. Am J Surg 189:56–60

    Article  PubMed  Google Scholar 

  9. Basdanis G, Papadopoulos VN, Michalopoulos A, Apostolidis S, Harlaftis N (2004) Randomized clinical trial of stapled hemorrhoidectomy vs open with ligasure for prolapsed piles. Surg Endosc 12:2 (Epub ahead of print)

    Google Scholar 

  10. Hasse C, Sitter H, Brune M, Wollenteit I, Lorenz W, Rothmund M (2004) Konventionelle Exzision vs. Resektion mit dem Klammernahtgerät. Prospektiv, randomisierte Studie. Dtsch Med Wochenschr 129:1611–1617

    Article  CAS  PubMed  Google Scholar 

  11. Racalbuto A, Aliotta I, Corsaro G, Lanteri R, Di Cataldo A, Licata A (2004) Hemorrhoidal stapler prolapsectomy vs. Milligan-Morgan hemorrhoidectomy: a long-term randomized trial. Int J Colorectal Dis 19:239–244

    Article  CAS  PubMed  Google Scholar 

  12. Ebert K-H, Meyer HJ (2002) Die Klammernahtresektion bei Hämorrhoiden—eine Bestandsaufnahme nach zweijähriger Anwendung. Vergleich der Ergebnisse mit der Technik nach Milligan-Morgan. Zentralbl Chir 127:9–14

    Article  PubMed  Google Scholar 

  13. Amosi D, Werbin N, Kashtan H, Skornik Y, Greenberg R (2003) Stapled hemorrhoidectomy—early experience in 30 patients (article in Hebrew). Harefuah 142:654–658

    PubMed  Google Scholar 

  14. Bönner C, Prohm P, Störkel S (2001) Fournier-Gangrän als seltene Komplikation nach Staplerhämorrhoidektomie. Kasuistik und Literaturübersicht. Chirurg 72:1464–1466

    Article  PubMed  Google Scholar 

  15. Cipriani S, Pescatori M (2002) Acute rectal obstruction after PPH stapled haemorrhoidectomy. Colorectal Dis 4:367–370

    Article  PubMed  Google Scholar 

  16. Herold A, Kirsch JJ (2001) Komplikationen nach Stapler-Hämorrhoidektomie. Ergebnisse einer Umfrage in Deutschland. Coloproctology 23:8–16

    Google Scholar 

  17. Maw A, Eu K-W, Seow-Choen F (2002) Retroperitoneal sepsis complicating stapled hemorrhoidectomy. Dis Colon Rectum 45:826–828

    Article  PubMed  Google Scholar 

  18. McDonald PJ, Bona R, Cohen (2004) Rectovaginal fistula after stapled haemorrhoidopexy. Colorectal Dis 6:64–65

    Article  CAS  PubMed  Google Scholar 

  19. Molloy RG, Kingsmore D (2000) Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet 355:810

    CAS  PubMed  Google Scholar 

  20. Ripetti V, Caricato M, Arullani A (2002) Rectal perforation, retropneumoperitoneum, and pneumomediastinum after stapling procedure for prolapsed hemorrhoids. Dis Colon Rectum 45:268–270

    Article  PubMed  Google Scholar 

  21. Roos P (2000) Haemorrhoid surgery revised. Lancet 355:1648

    Article  CAS  Google Scholar 

  22. Schmidt MP, Fischbein J, Shatavi H (2002) Stapler-Hämorrhoidectomy vs. plastisch-rekonstruktive Verfahren. OP-Verfahren im klinischen Vergleich. Zentralbl Chir 127:15–18

    Article  CAS  PubMed  Google Scholar 

  23. Zaheer S, Reilly WT, Pemberton JH, Ilstrup D (1998) Urinary retention after operations for benign anorectal diseases. Dis Colon Rectum 41:696–704

    CAS  PubMed  Google Scholar 

  24. Wilson MS, Pope V, Doran HE, Fearn SJ, Brough WA (2002) Objective comparison of stapled anopexy and open hemorrhoidectomy. Dis Colon Rectum 45:1437–1444

    Article  CAS  PubMed  Google Scholar 

  25. Arbman G, Krook H, Haapaniemi S (2000) Closed vs. open hemorrhoidectomy—is there a difference? Dis Colon Rectum 43:31–34

    CAS  PubMed  Google Scholar 

  26. Armstrong DN, Frankum C, Scherzer ME, Ambroze WL, Orangio GR (2002) Harmonic scalpel hemorrhoidectomy. Dis Colon Rectum 45:354–359

    Article  PubMed  Google Scholar 

  27. Cheetham MJ, Mortensen NJM, Nystrom PO, Kamm MA, Phillips RKS (2000) Persistent pain and faecal urgency after stapled haemorrhoidectomy. Lancet 356:730–733

    PubMed  Google Scholar 

  28. Chen W, Huang T, Hsu G, Chen H, Chiu C, Hsiao K, Chi P, Lai Y (2002) Stapled hemorrhoidectomy—prospective analysis of 180 patients. Dis Colon Rectum 45(4):A36–A37 (abstract)

    Article  Google Scholar 

  29. Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S (2001) Prospective randomized multicentre trial comparing stapled with open haemorrhoidectomy. Br J Surg 88:669–674

    Article  CAS  PubMed  Google Scholar 

  30. Kirsch JJ, Staude G, Herold A (2001) Hämorrhoidektomien nach Longo und Milligan-Morgan. Prospektive Vergleichsstudie mit 300 Patienten. Chirurg 72:180–185

    Article  CAS  Google Scholar 

  31. Au-Yong I, Rowsell M, Hemingway DM (2004) Randomised controlled clinical trial of stapled haemorrhoidectomy vs. conventional haemorrhoidectomy; a three and a half year follow up. Colorectal Dis 6:37–38

    Article  CAS  PubMed  Google Scholar 

  32. Shalaby R, Desoky A (2001) Randomized clinical trial of stapled versus Milligan–Morgan haemorrhoidectomy. Br J Surg 88:1049–1053

    Article  CAS  PubMed  Google Scholar 

  33. Mascagni D, Zeri KP, Di Matteo FM, Peparini N, Maturo A, Berni A (2003) Stapled hemorrhoidectomy: surgical notes and results. Hepato-gastroenterol 50:1878–1882

    Google Scholar 

  34. Peng BC, Jayne DG, Ho Y-H (2003) Randomized trial of rubber band ligation vs. stapled hemorrhoidectomy for prolapsed piles. Dis Colon Rectum 46:291–297

    Article  PubMed  Google Scholar 

  35. Singer MA, Cintrom JR, Fleshman JW, Chaudry V, Birnbaum EH, Read TE, Spitz JS, Abcarian H (2002) Early experience with stapled hemorrhoidectomy in the United States. Dis Colon Rectum 45:360–369

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors thank the administrative personnel of the Proctological Office for their support in collecting and continuously updating the data concerning the stapler patients. The authors also thank Mr. Anthony Senagore for critically revising the manuscript and Ms. Claudia Killaitis for the statistical evaluation.

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Authors and Affiliations

  1. Department of Surgical Proctology and Proctological Office, Park-Klinik, Goethestraße 11, 24116, Kiel, Germany

    Johannes Jongen, Jens-Uwe Bock, Hans-Günter Peleikis & Anne Eberstein

  2. Department of Surgery, University of Regensburg, Franz Josef Strauss Allee 11, 93053, Regensburg, Germany

    Karin Pfister

  3. Proktologische Praxis Kiel, Beselerallee 67, 24105, Kiel, Germany

    Johannes Jongen

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  1. Johannes Jongen
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  2. Jens-Uwe Bock
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Correspondence to Johannes Jongen.

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Jongen, J., Bock, JU., Peleikis, HG. et al. Complications and reoperations in stapled anopexy: learning by doing. Int J Colorectal Dis 21, 166–171 (2006). https://doi.org/10.1007/s00384-005-0784-8

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  • DOI: https://doi.org/10.1007/s00384-005-0784-8

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