Stapled haemorrhoidectomy: bothersome staple line bleeding.
BACKGROUND
The stapled haemorrhoidectomy procedure has been popularized as a painless and effective treatment for prolapsing haemorrhoidal disease. We have noted that staple line bleeding is a contributory factor to postoperative morbidity.


METHODS
This was a retrospective analysis of the clinical records of consecutive stapled haemorrhoidectomy procedures performed in patients over a 1-year period. The outpatient, operative and inpatient records were reviewed. We assessed the incidence of intraoperative staple line bleeding, its management and early postoperative outcomes in our patients undergoing stapled haemorrhoidectomy.


RESULTS
From March 2000 to March 2001, 39 stapled haemorrhoidectomy procedures were performed. Intraoperative staple line bleeding was recorded in 17 patients (44%) and suture reinforcement of this staple line was required in 12 (31%). Nine patients (23%) were admitted for postoperative per rectal bleeding, four of whom required surgical haemostasis of bleeding points along the staple line. Delayed secondary haemorrhage was seen in one patient. The incidence of postoperative bleeding in patients with noted staple line bleeding was 35%, compared with 14% in those without evidence of bleeding.


CONCLUSIONS
Staple line bleeding is a technical difficulty and complication associated with stapled haemorrhoidectomy. It should be managed with meticulous haemostatic suture placement in order to avoid postoperative bleeding and the morbidity of re-operation for haemostasis.
Koh
Dean C S
DC
Department of General Surgery, Tan Tock Seng Hospital, Singapore. Dean_Koh@ttsh.com.sg
Cheong
Denis M O
DM
Wong
Kutt Sing
KS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003113:Colonoscopy / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000175:diagnosis / Q000601:surgery*; D006489:Hemostatic Techniques; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012846:Singapore; D013528:Surgical Staplers / Q000009:adverse effects*; D016896:Treatment Outcome