title: Proctalgia as a late complication of stapled hemorrhoidectomy. Report of our case series.
abstract: BACKGROUND
  Incidence and etiology of persistent pain after stapled hemorrhoidectomy remain uncertain. Characteristics, clinical course and management of this complication have not yet been assessed. Purpose of this essay is to describe our experience with persistent pain in our series of patients with this technique.
  
  
  METHODS
  This retrospective study evaluated 126 cases of stapled hemorrhoidectomy treated from 2006 to 2009. We gathered information on each patient regarding type of prolapsed hemorrhoids, number of haemostatic suture placed, histology of each doughnut and post operative complications. A close follow up was done in those patients complaining about pain.
  
  
  RESULTS
  Early and late complications occurred in 11.9% and 16.7% of patients respectively. At two weeks from surgery 18 patients (14.3%) were complaining of persistent pain. The average number of haemostatic sutured placed in this group and in all series is 4.5 and 2.5 respectively. Eight patients (6.34%), 3 (2.4%) and 2 (1.6%) patients were still complaining of persistent pain at 1 month, 4 months and 6 months of follow up, respectively. In these patients, endoanal manometry was normal at 4 months from surgery, while endoanal ultrasound showed retained staples in 3 of them. At 7 months from surgery a staples removal was performed in 2 patients that were still complaining of pain.
  
  
  CONCLUSIONS
  Incidence of pain at 2 weeks after surgery resulted in 14.3% of patients. In most patients its etiology remains unclear but we reckon it might be related to the high number of haemostatic sutures placed. Staples removal resulted successfully.
authors.affiliation: Department of Emergency Surgery, Policlinico Tor Vergata, "Tor Vergata" University Hospital, Viale Oxford 81, 00133 Rome, Italy. .benny078@libero.it
authors.forename: Benedetto
authors.initials: B
authors.lastname: Ielpo
authors.forename: Dario
authors.initials: D
authors.lastname: Venditti
authors.forename: Valerio
authors.initials: V
authors.lastname: Balassone
authors.forename: Umberto
authors.initials: U
authors.lastname: Favetta
authors.forename: Oreste
authors.initials: O
authors.lastname: Buonomo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Petrella
mesh_terms: D000328:Adult; D000368:Aged; D001003:Anal Canal / Q000000981:diagnostic imaging; D000700:Analgesics / Q000627:therapeutic use; D020878:Device Removal; D005260:Female; D005500:Follow-Up Studies; D006484:Hemorrhoids / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology* / Q000628:therapy; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000009:adverse effects*; D013537:Sutures / Q000009:adverse effects / Q000706:statistics & numerical data; D014463:Ultrasonography
chemical_list: D000700:Analgesics