title: High-grade hemorrhoids requiring surgical treatment are common after laparoscopic ventral mesh rectopexy.
abstract: OBJECTIVE
  To describe patients developing grade III and IV hemorrhoids requiring surgery after laparoscopic ventral mesh rectopexy (LVMR) and to explore the relationship between developing such hemorrhoids and recurrence of rectal prolapse after LVMR.
  
  
  METHODS
  All consecutive patients receiving LVMR at the Meander Medical Centre, Amersfoort, the Netherlands, between 2004 and 2013 were analyzed. Kaplan-Meier estimates were calculated for recurrences.
  
  
  RESULTS
  A total of 420 patients underwent LVMR. Sixty-five of these patients (actuarial 5-year incidence 24.3, 95 % confidence interval (CI) 18.6-30.0) developed symptomatic grade III/IV hemorrhoids requiring stapled or excisional hemorrhoidectomy. Re-do surgery for recurrent grade III/IV hemorrhoids was required for 15 of the 65 patients (actuarial 5-year recurrence rate 40.6, 95 % CI 23.2-58.0) after the primary hemorrhoidectomy. Three of the 65 patients developed an external rectal prolapse (ERP) recurrence and eight an internal rectal prolapse (IRP) recurrence. This generated a 5-year recurrence rate of 25.3 % (95 % CI 0-53.9) for ERP recurrence and 24.4 % (95 % CI 9.1-39.7) for IRP recurrence. The rest of the LVMR cohort not receiving additional surgery for hemorrhoids (n = 355) showed significantly lower actuarial 5-year ERP (0.8 %, p = 0.011) and IRP (11 %, p = 0.020) recurrence rates.
  
  
  CONCLUSIONS
  High-grade hemorrhoids requiring surgery may be common after LVMR. The development of high-grade hemorrhoids after LVMR might be considered a predictor of rectal prolapse recurrence.
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands. jj.vaniersel@meandermc.nl.|Institute of Technical Medicine, MIRA, Twente University, Enschede, The Netherlands. jj.vaniersel@meandermc.nl.
authors.forename: J J
authors.initials: JJ
authors.lastname: van Iersel
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: H A
authors.initials: HA
authors.lastname: Formijne Jonkers
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: P M
authors.initials: PM
authors.lastname: Verheijen
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Draaisma
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.
authors.forename: E C J
authors.initials: EC
authors.lastname: Consten
authors.affiliation: Department of Surgery, Meander Medical Centre, Maatweg 3, 3813 TZ, Amersfoort, The Netherlands.|Institute of Technical Medicine, MIRA, Twente University, Enschede, The Netherlands.
authors.forename: I A M J
authors.initials: IA
authors.lastname: Broeders
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006484:Hemorrhoids / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012005:Rectal Prolapse / Q000473:pathology / Q000601:surgery*; D012007:Rectum / Q000601:surgery; D012008:Recurrence; D013526:Surgical Mesh; D016896:Treatment Outcome
keywords: Hemorrhoidectomy; Hemorrhoids; Laparoscopic ventral mesh rectopexy; Rectal prolapse; Recurrence