title: Complications, recurrences, early and late reoperations after stapled haemorrhoidopexy: lessons learned from 1,233 cases.
abstract: OBJECTIVE
  The purpose of the study was to analyse the outcomes of all patients requiring a reoperation after an initial circular stapled haemorrhoidopexy (SH) for prolapsing haemorrhoids.
  
  
  METHODS
  Data of all patients undergoing a circular SH from 1998 thru 2007 available in a prospectively collected database were reviewed, and all patients who had reoperations were studied.
  
  
  RESULTS
  During the study period, 1,233 patients (551 females, median age 52 years) underwent a circular SH. Complete follow-up was available in all patients (median follow-up 7 months, range 0.5-100); 127 patients (10.3%) required one or more reoperations. Early reoperations (<30 days) were necessary in 47 patients (3.8%), and 45 (3.6%) were stapler-related complications. Late reoperations (>30 days) were performed in 84 patients (6.8%) and 57 (4.6%) were stapler-related. A learning curve was observed with significant reduction of early (<30 days) and late (>30 days) reoperation rate with time.
  
  
  CONCLUSIONS
  Reoperations after SH are necessary in about 10% of the patients. The majority of the reoperations are due to either complications arising from circular SH, recurrent/persistent haemorrhoidal symptoms or other anorectal issues not addressed by the circular SH procedure (3.8% early; 6.8% late). Circular SH appears to be an effective procedure for symptomatic haemorrhoidal disease; however, training and learning curve issues should be addressed to minimise treatment failures.
authors.affiliation: Proctological Office Kiel, Beselerallee 67, 24105, Kiel, Germany. jjongen@proktologie-kiel.de
authors.forename: Johannes
authors.initials: J
authors.lastname: Jongen
authors.forename: Anne
authors.initials: A
authors.lastname: Eberstein
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Bock
authors.forename: Hans-Günter
authors.initials: HG
authors.lastname: Peleikis
authors.forename: Volker
authors.initials: V
authors.lastname: Kahlke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology* / Q000601:surgery*; D012005:Rectal Prolapse / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D012307:Risk Factors; D017792:Surgical Stapling / Q000009:adverse effects*; D055815:Young Adult