Reinterventions for specific technique-related complications of stapled haemorrhoidopexy (SH): a critical appraisal.
BACKGROUND
Stapled haemorrhoidopexy (SH) is an attractive alternative to conventional haemorrhoidectomy (CH) because of reduced pain and earlier return to normal activities. However, complication rates are as high as 31%. Although some complications are similar to CH, most are specifically technique-related. In this prospective audit, we report our experience with the management of some of these complications.


METHODS
Data on patients undergoing SH at our unit or referred to us are prospectively entered in a database. The onset or duration of specific SH-related complications as well as reinterventions for failed or complicated SH was recorded.


RESULTS
From 1/03 to 10/07, 110 patients underwent SH, while 17 patients were referred after complicated/failed SH. Overall early and late complication rates after SH were 12.7% and 27.2%, respectively. Overall reintervention rate was 9.1%. Among the referred SH-group, one patient underwent Hartmann's procedure because of rectal perforation. The remaining 16 patients experienced at least one of the following: recurrence, urgency, frequency, severe persistent anal pain, colicky abdominal pain, anal fissure and stenosis. Four patients underwent CH with regular postoperative recovery. Two patients underwent exploration under anaesthesia because of persisting pain. One patient underwent anoplasty.


CONCLUSIONS
SH presents unusual and challenging complications. Abuses should be minimized and longer-term studies are needed to further clarify its role.
Sileri
Pierpaolo
P
Department of Surgery, University of Rome Tor Vergata, Rome, Italy. piersileri@yahoo.com
Stolfi
Vito Maria
VM
Franceschilli
Luana
L
Perrone
Federico
F
Patrizi
Lodovico
L
Gaspari
Achille Lucio
AL