Complications after stapled hemorrhoidectomy: can they be prevented?

Area of Science:

• Coloproctology
• Surgical Innovation
• Gastroenterology

Background:

• Hemorrhoids are a common condition requiring effective treatment.
• Stapled hemorrhoidectomy (SH) is a newer surgical approach for hemorrhoid treatment.
• Evaluating the safety and efficacy of SH is crucial.

Purpose of the Study:

• To assess the complication rate of stapled hemorrhoidectomy (SH).
• To identify common immediate and delayed complications associated with SH.
• To analyze the impact of surgeon experience on SH outcomes.

Main Methods:

• A retrospective review of 1,107 patients undergoing SH across twelve Italian centers.
• Data collection on immediate (first week) and delayed complications.
• Analysis of complication rates based on surgeon experience (first 25 cases vs. >25 cases).

Main Results:

• A 15% overall complication rate was observed (164/1,107 patients).
• Common immediate complications included severe pain (5.0%), bleeding (4.2%), and thrombosis (2.3%).
• Delayed complications included hemorrhoid recurrence (2.3%) and stenosis (0.8%).
• Complications were more frequent in surgeons with less than 25 SH cases (65% of complications occurred after 25 cases).
• Bleeding was the most frequent complication in the initial 25 cases (48%).

Conclusions:

• Stapled hemorrhoidectomy (SH) presents a notable complication rate, necessitating careful patient selection and surgical technique.
• Surgeon experience significantly influences complication rates, with a learning curve evident.
• Further multicenter randomized trials comparing SH with traditional banding are recommended for definitive evidence.