title: Does the removal of retained staples really improve postoperative chronic sequelae after transanal stapled operations?
abstract: BACKGROUND
  Transanal stapled procedures are increasingly being used. Several postoperative complications can be referred to their application, including those related to the presence of retained staples at the level of the staple line.
  
  
  OBJECTIVE
  This study was conducted to assess whether the removal of the retained staples is a useful approach to improve some of the most common postoperative complications of these surgical techniques.
  
  
  METHODS
  This is a retrospective study.
  
  
  METHODS
  The study was conducted at the One-Day Surgery Unit of St. Andrea Hospital.
  
  
  METHODS
  All of the patients who underwent a stapled transanal procedure from January 2003 to December 2011 were included in the study. Patients included in the study were followed postoperatively for 1 year after surgery to identify the presence of retained staples.
  
  
  METHODS
  If identified, the retained staples were removed endoscopically or transanally.
  
  
  METHODS
  After the staple removal, patients were followed with biweekly office visit for 2 months to evaluate the progression of symptoms.
  
  
  RESULTS
  From the 566 patients included in the study, 165 experienced postoperative complications, and in 66 of these cases, retained staples were found and removed. With the removal of retained staples, symptoms were almost all resolved or improved. In only 1 case did the retained staples removal not modify the symptoms.
  
  
  CONCLUSIONS
  The study design may have introduced potential selection bias. In addition, the study was limited by the lack of a specific questionnaire for the evaluation of symptoms improvement.
  
  
  CONCLUSIONS
  The removal of the retained staples is an efficacious and safe procedure to solve or improve postoperative complications and should be always considered.
authors.affiliation: Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea Hospital, School of Medicine and Psychology, University Sapienza of Rome, Rome, Italy.
authors.forename: Francesco Saverio
authors.initials: FS
authors.lastname: Mari
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Tatiana
authors.initials: T
authors.lastname: Di Cesare
authors.forename: Marcello
authors.initials: M
authors.lastname: Gasparrini
authors.forename: Barbara
authors.initials: B
authors.lastname: Flora
authors.forename: Carola
authors.initials: C
authors.lastname: Sebastiani
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pancaldi
authors.forename: Antonio
authors.initials: A
authors.lastname: Brescia
mesh_terms: D020878:Device Removal; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011446:Prospective Studies; D012002:Rectal Diseases / Q000601:surgery*; D012307:Risk Factors; D013537:Sutures; D016896:Treatment Outcome