title: Outcome of repeated stapler haemorrhoidopexy for recurrent prolapsing haemorrhoids.
abstract: OBJECTIVE
  Stapled haemorrhoidopexy (SH) is associated with minor postoperative pain and high overall satisfaction rates. Some patients will have persistent or recurrent symptoms requiring re-intervention.
  
  
  METHODS
  All patients who underwent SH for grade III internal haemorrhoids and required a second SH (2005-2008) were studied. Grade IV patients were excluded. Data on surgical technique, postoperative pain, complications, time to first bowel movement, functional recovery and suspected reason for first SH failure were retrieved from medical records. Similar data were collected for the second procedure at four postoperative follow-up visits.
  
  
  RESULTS
  Twelve patients were enrolled. The mean time to recurrent symptoms was 15 months. The indications for repeated surgery were bleeding, prolapse, and pruritus w/wo discharge. Recurrence was attributed to a too high staple line in the first procedure (n = 4) and an incomplete resected ring (n = 1). The median operative time of the second procedure was 24 min (17-29) and the median follow up was 20 ± 4.3 months (15-30). Repeat SH was associated with higher pain scores, more analgesic requirements, and longer recovery period compared to the first procedure. There were no early or late postoperative complications. Histological examination of the 12 tissue doughnuts resected during the second SH showed no smooth muscle fibres in any of the patients. After 12 months of follow up, 10 patients with repeated SH remained asymptomatic, while 2 had recurrent bleeding.
  
  
  CONCLUSIONS
  Repeat SH can be performed safely and reliably without risk of complications, but the second SH is associated with more pain and longer recovery time.
authors.affiliation: Department of Surgery A, Tel-Aviv Medical Center and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
authors.forename: I
authors.initials: I
authors.lastname: White
authors.forename: S
authors.initials: S
authors.lastname: Avital
authors.forename: R
authors.initials: R
authors.lastname: Greenberg
mesh_terms: D000328:Adult; D005260:Female; D006470:Hemorrhage / Q000209:etiology*; D006484:Hemorrhoids / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology; D011391:Prolapse; D011538:Pruritus Ani / Q000209:etiology; D012008:Recurrence; D012086:Reoperation / Q000009:adverse effects; D013536:Suture Techniques / Q000009:adverse effects*; D013997:Time Factors; D017211:Treatment Failure