title: Stapled anastomosis for anterior resection is safe even after previous stapled haemorrhoidectomy--a report of five cases.
abstract: BACKGROUND
  Stapled haemorrhoidectomy has become popular for the treatment of symptomatic bleeding or prolapsing piles. There are concerns about the safety of another stapled low colorectal anastomosis after rectal resection if a patient who has had previous stapled haemorrhoidectomy subsequently develops colorectal neoplasia requiring an anterior resection.
  
  
  METHODS
  A retrospective review of patients who underwent stapled haemorrhoidectomy and subsequently had anterior resection from 1999 to 2008 was performed.
  
  
  RESULTS
  Five patients (all male) were found to have distal sigmoid or rectal tumours on surveillance colonoscopy after stapled haemorrhoidectomy. Median age was 65 years (range 58-71). All underwent anterior resection with stapled end-to-end colorectal anastomosis at median of 29 months (range 18-60 months) after the initial stapled haemorrhoidectomy. Median anastomotic height was 12 cm (range 1-12 cm). A defunctioning ileostomy was created for three out of five patients. All the colorectal anastomoses healed uneventfully.
  
  
  CONCLUSIONS
  Stapled colorectal anastomosis may be safely performed after previous stapled haemorrhoidectomy.
authors.affiliation: Department of Colorectal Surgery, Singapore General Hospital, Outram Road, 169608, Singapore, Republic of Singapore.
authors.forename: Wan-Pei
authors.initials: WP
authors.lastname: Fu
authors.forename: Hak-Mien
authors.initials: HM
authors.lastname: Quah
authors.forename: Choong-Leong
authors.initials: CL
authors.lastname: Tang
authors.forename: Boon-Swee
authors.initials: BS
authors.lastname: Ooi
authors.forename: Kong-Weng
authors.initials: KW
authors.lastname: Eu
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome