title: Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients.
abstract: BACKGROUND
  Hemorrhoidal disease is highly prevalent in the western world. Stapled hemorrhoidopexy also known as the procedure for prolapsed hemorrhoids (pph) has been shown to be superior to conventional hemorrhoidectomy with regard to postoperative pain, length of hospital stay and early return to work. Proctitis following stapled hemorrhoidopexy has not been reported previously. Herein, we report our experience with proctitis in patients following stapled hemorrhoidopexy and question if proctitis could be a complication of stapled hemorrhoidopexy.
  
  
  METHODS
  A retrospective analysis of the data of patients undergoing stapled hemorrhoidopexy with the PPH03 in the coloproctology unit of the department of surgery of a primary care hospital in Germany within a 5-year period was performed. All cases were managed and followed up by a single attending surgeon with expertise in coloproctology.
  
  
  RESULTS
  129 patients were included for analysis including 21 cases with grade 2, 103 cases of grade 3 and 5 cases of grade 4 hemorrhoids. The median duration of surgery was 20 min. 17 complications including two recurrences were recorded. Post-pph proctitis was recorded in 14 cases (10.9 %). Post-pph proctitis was not associated with gender, extent of hemorrhoidal disease, BMI and ASA (p >0.05). All cases recovered within 4 weeks following management with nonsteroidal anti-inflammatory drugs and suppositories.
  
  
  CONCLUSIONS
  Proctitis could be a complication of stapled hemorrhoidopexy with a good response to conservative treatment with suppositories.
authors.affiliation: Helios Klinikum Wuppertal, Department of Surgery II, University of Witten-Herdecke, Heusnerstr. 40, 42283 Wuppertal, Germany ; Chirurgische Klinik, St. Remigius Krankenhaus Opladen, An St. Remigius 26, 51379 Leverkusen, Germany.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Ambe
authors.affiliation: Chirurgische Klinik, St. Remigius Krankenhaus Opladen, An St. Remigius 26, 51379 Leverkusen, Germany.
authors.forename: Dirk R
authors.initials: DR
authors.lastname: Wassenberg
keywords: Hemorrhoidectomy; Hemorrhoids; Procedure for prolapsed hemorrhoids; Proctitis; Stapled hemorrhoidopexy