Fecal urge incontinence after stapled anopexia for prolapse and hemorrhoids: a prospective, observational study.
BACKGROUND
Stapled anopexia was introduced as a surgical method in 1993. Long-term data with special interest in functional results and relapse symptoms are rarely presented. Urinary discomfort and problems with fecal urge incontinence are addressed as severe side effects. We present our long-term results (using data from a high-volume center) with this technique and two surgeons' experience.


METHODS
During 4 years, a total of 546 patients entered the study. For long-term evaluation, 452 patients (237 women and 215 men) were available (82.9%). Patients with recurrent hemorrhoidal prolapse and fecal incontinence were excluded. Postoperative reevaluation with physical condition was performed after 1, 6, and 24 months by means of manometry, rectoscopy, and SF-36 Health Survey Test.


RESULTS
Early postoperative urinary impairment was 7.3%. Early fecal urge incontinence rate was 3.3%. Overall perioperative complication rate was 11.1%. Within 1 month, the rate of fecal urge incontinence increased to 13.5% and decreased to 4% and 2.9% after a period of 6 and 24 months. Overall recurrence rate was 3.3%. Reoperation rate according to the primary indication was 2.9% after 24 months. The SF-36 data showed a return to normal 1 month after the procedure was performed. Overall satisfaction rate was 95.4%.


CONCLUSIONS
Our study demonstrates that stapled anopexia is a safe and secure procedure for treatment of hemorrhoidal prolapse. Fecal urge incontinence is a self-limiting side effect that with which patients need to be made familiar.
Schmidt
Johannes
J
Department of Surgery, LAKUMED, Teaching Hospital Technical University Munich (TUM), Landshut, Germany. johannes.schmidt@kh-landshut-achdorf.de
Dogan
Nevzat
N
Langenbach
Ralf
R
Zirngibl
Hubert
H
D005242:Fecal Incontinence / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D010865:Pilot Projects; D011446:Prospective Studies; D012005:Rectal Prolapse / Q000601:surgery*; D012086:Reoperation; D017792:Surgical Stapling / Q000009:adverse effects*