Advertisement

Hemorrhoids pp 325-336 | Cite as

Main Disadvantages of Stapled Hemorrhoidopexy

  • Michele Schiano di Visconte
  • Arianna Pasquali
  • Tommaso Cipolat Mis
Reference work entry
Part of the Coloproctology book series (COLOPROCT, volume 2)

Abstract

The Longo technique, described in 1993, is proposed for the treatment of hemorrhoidal disease. The stapled hemorrhoidopexy has been introduced as an alternative to conventional hemorrhoidectomy. Despite a clear perioperative advantage regarding pain and patient comfort, the stapled hemorrhoidopexy may be followed by unusual postoperative complications. Complications may occur after stapled hemorrhoidopexy, some are particularly serious, especially bleeding and sepsis. Since 2002 more than 130 articles have been published reporting complications during and after stapled hemorrhoidopexy.

Complications were classified as being either early or late if they occurred within 7 days of the operation. Those occurring after 7 days were considered to be late.

The most common complication is early bleeding. Severe postoperative pain could be caused by dehiscence of the anastomosis or due to the fact that the anastomosis is too near to the linea dentata.

A lot of long-term complications have been described. Most of them are related to either an incorrect indication for surgery or technical errors. Severe complications leading to death have been described but are rare. The persistent anal pain after stapled hemorrhoidopexy has in the most cases the objective findings of the staple line hardened and fixed to muscular layer beyond. Irreversible urge incontinence due to lesions of the sphincter muscle or a diminished rectal capacity due to resection of too much mucosa is quite common complication if the procedure is not performed properly. Rectovaginal fistulas and anastomotic diverticula are very rare but possible.

References

  1. Ambe PC, Wassenberg DR (2015) Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients. Patient Saf Surg 9:36CrossRefPubMedPubMedCentralGoogle Scholar
  2. Angelone G, Giardiello C, Prota C (2006) Stapled hemorrhoidopexy. Complications and 2-year follow-up. Chir Ital 58(6):753–760PubMedGoogle Scholar
  3. Beattie GC, Lam JPH, Loudon MA (2000) A prospective evaluation of the introduction of circumferential stapled anoplasty in the management of haemorrhoids and mucosal prolapse. Color Dis 2:137–142CrossRefGoogle Scholar
  4. Beck DE (2004) Alastair C. J. Windsor, M.B.B.S., M.D., F.R.C.S., F.R.C.S. (Ed). Clin Colon Rectal Surg 17(02):75CrossRefPubMedCentralGoogle Scholar
  5. Benedetto B, Venditti D, Balassone V, Favetta U, Buonomo O, Petrella G (2010) Proctalgia as a late complication of stapled hemorrhoidectomy. Report of our case series. Int J Surg 8:648–752CrossRefGoogle Scholar
  6. Blouhos K, Vasiliadis K, Tsalis K, Botsios D, Vrakas X (2007) Uncontrollable intra-abdominal bleeding necessitating low anterior resection of the rectum after stapled hemorrhoidopexy: report of a case. Surg Today 37(3):254–257CrossRefPubMedPubMedCentralGoogle Scholar
  7. Brusciano L, Aybaca SM, Pescatori M, Accarpio GM, Dod G, Cavallari F, Ravo B, Annibali R (2004) Reinterventions after complicated or failed stapled hemorrhoidopexy. Dis Colon Rectum 47:1846–1851CrossRefPubMedPubMedCentralGoogle Scholar
  8. Butterworth JW, Peravalli R, Anwar R, Ali K, Bekdash B (2012) A four year retrospective study and review of selection criteria and post-operative complications of stapled haemorrhoidopexy. Tech Coloproctol 16:369–372CrossRefPubMedGoogle Scholar
  9. Buyukasik O, Hasdemir OA, Col C (2009) Rectal lumed obliteration from stapled hemorrhoidopexy: can be prevented? Tech Coloproctol 13:333–335CrossRefPubMedGoogle Scholar
  10. Ceci F, Picchio M et al (2008) Long-term outcomes of stapled hemorrhoidopexy for grade III and grade IV hemorrhoids. Dis Colon Rectum 51:1107–1112CrossRefPubMedGoogle Scholar
  11. Cheetham MJ, Mortensen NJM, Nystrom PO, Kamm MA, Philips RKS (2000) Persistent pain and fecal urgency after stapled haemorrhoidectomy. Lancet 356:730–733CrossRefPubMedPubMedCentralGoogle Scholar
  12. De Santis G, Gola P et al (2012) Sigmoid intramural hematoma and hemoperitoneum: an early severe complication after stapled hemorrhoidopexy. Tech Coloproctol 16:315–317CrossRefPubMedGoogle Scholar
  13. Efthimiadis C, Kosmidis C, Grigoriou M, Anthimidis G, Vasiliadou K, Baka S, Gerasimidou D, Basdanis G (2011) The stapled hemorrhoidopexy syndrome: a new clinical entity? Tech Coloproctol 15(Suppl 1):S95–S99CrossRefPubMedGoogle Scholar
  14. Faucherin JL, Voirin D et al (2010) Rectal perforation with life-threatening peritonitis following stapled haemorrhoidopexy. Color Dis 12(Suppl 3):48Google Scholar
  15. Ganio E, Altomare DF, Milito G, Gabrielli F, Canuti S (2007) Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy. Br J Surg 94:1033–1037CrossRefPubMedPubMedCentralGoogle Scholar
  16. Gerjy R, Derwinger K, Lindhoff-Larson A, Nystrom PO (2011) Long-term results of stapled haemorrhoidopexy in a prospective single centre study of 153 patients with 1–6 years’ follow-up. Color Dis 14:490–496CrossRefGoogle Scholar
  17. Grigoropoulos P, Kalles V et al (2001) Early and late complications of stapled hemorrhoidopexy: a 6-year experience from a single surgical clinic. Tech Coloproctol 15(Suppl 1):S79–S81Google Scholar
  18. Kanellos I, Zacharakis E, Kanellos D, Pramateftakis MG, Tsachalis T, Betsis D (2006) Long-term results after stapled haemorrhoidopexy for third-degree haemorrhoids. Tech Coloproctol 10:47–49CrossRefPubMedPubMedCentralGoogle Scholar
  19. Khubchandani I, Fealk MH, Reed JF (2009) Is there a post-PPH syndrome? Tech Coloproctol 13(2):141–144CrossRefPubMedGoogle Scholar
  20. Lee SD, Jung ST et al (2016) Persistent bleeding following a stapled hemorrhoidopexy. Ann Coloproctol 32(3):120–122CrossRefPubMedPubMedCentralGoogle Scholar
  21. Lo TS, Huang YH, Dass AK, Karim N, Uy-Patrimonio MC (2016) Rectovaginal fistula: twenty years of rectovaginal repair. J Obstet Gynaecol Res 42:1361–1368CrossRefPubMedGoogle Scholar
  22. Ng KH, Ho KS, Ooi BS, Tang CL, Eu KW (2006) Experience of 3711 stapled haemorrhoidectomy operations. Br J Surg 93:226–230CrossRefPubMedPubMedCentralGoogle Scholar
  23. Pescatori M, Gagliardi G (2008) Postoperative complications after procedure for prolapsed hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures. Tech Coloproctol 12:7–19CrossRefPubMedPubMedCentralGoogle Scholar
  24. Pescatori M, Spyrou M, Cobellis L, Bottini C, Tessera G (2006) Rectal pocket syndrome after stapled mucosectomy. Color Dis 8:808–811CrossRefGoogle Scholar
  25. Petersen S, Jongen J (2001) Agraffectomy after low rectal stapling procedures for hemorrhoids and rectocele. Tech Coloproctol 15:259–264CrossRefGoogle Scholar
  26. Petersen S, Hellmich G, Schumann D, Schuster A, Ludwig K (2004) Early rectal stenosis following stapled rectal mucosectomy for hemorrhoids. BMC Surg 4:6CrossRefPubMedPubMedCentralGoogle Scholar
  27. Pinto ER, Sarmento JA, Azevedo F, Macedo G (2014) Rectal ischemia after stapled hemorrhoidopexy causing pain or bleeding: report of three cases. Tech Coloproctol 18:667–668CrossRefGoogle Scholar
  28. Plocek MD, Kondylis LA et al (2006) Hemorrhoidopexy staple line height predicts return to work. Dis Colon Rectum 49:1905–1910CrossRefPubMedGoogle Scholar
  29. Porrett LJ, Porrett JK, Ho YH (2015) Documented complications of staple hemorrhoidopexy: a systematic review. Int Surg 100:44–57CrossRefPubMedPubMedCentralGoogle Scholar
  30. Raahave J, Jepsen LV, Pedersen JK (2008) Primary and repeated stapled hemorrhoidopexy for prolapsing haemorrhoids: follow-up to five years. Dis Colon Rectum 51:334–341CrossRefPubMedGoogle Scholar
  31. Reichert M, Schwandner T, Hecker A, Behnk A, Baumgart-Vogt E, Wagenlehner F, Padberg W (2014) Surgical approach for repair of rectovaginal fistula by modified Martius flap. Geburtshilfe Frauenheilkd 74(10):923–927CrossRefPubMedPubMedCentralGoogle Scholar
  32. Rothenberger DA, Goldberg SM (1983) The management of rectovaginal fistuale. Surg Clin North Am 63(1):61–79CrossRefPubMedGoogle Scholar
  33. Shao WJ, Li GC, Zhang ZH, Yang BL (2008) Systematic review and meta-analysis of randomized controlled trials comparing stapled haemorrhoidopexy with conventional haemorrhoidectomy. Br J Surg 95:147–160CrossRefPubMedPubMedCentralGoogle Scholar
  34. Stolfi VM, Sileri P, Micossi M (2008) Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy. J Gastrointest Surg 12:795–801CrossRefPubMedGoogle Scholar
  35. Sultan S, Rabhi N, Etienney I, Atienza P (2010) Stapled haemorrhoidopexy: 6 years’ experience of a referral centre. Color Dis 12:921–926CrossRefGoogle Scholar
  36. van Wensen RJA, van Leuken MH et al (2008) Pelvic sepsis after stapled hemorrhoidopexy. World J Gastroenterol 14(38):5924–5926CrossRefPubMedPubMedCentralGoogle Scholar
  37. White I, Avital S, Greensbeg R (2011) Outcome of repeated stapler haemorrhoidopexy for recurrent prolapsing haemorrhoids. Color Dis 13:1048–1051CrossRefGoogle Scholar
  38. Zmora O, Colquhoun P, Abramson D, Weiss EG (2004) Can the procedure for prolapsing haemorrhoids (PPH) be done twice? Result of a porcine model. Surg Endosc 18:757–761CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Michele Schiano di Visconte
    • 1
  • Arianna Pasquali
    • 2
  • Tommaso Cipolat Mis
    • 2
  1. 1.Department of General SurgeryColorectal and Pelvic Floor Diseases Center, S. Maria dei Battuti HospitalConegliano Veneto (TV)Italy
  2. 2.Department of General SurgeryAzienda Sanitaria Universitaria Integrata - University of TriesteTriesteItaly

Personalised recommendations