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Reinterventions after complicated or failed stapled hemorrhoidopexy.

L Brusciano1, S M Ayabaca, M Pescatori

  • 1Coloproctology Unit, Villa Flaminia Hospital, Rome, Italy.

Diseases of the Colon and Rectum
|December 29, 2004
PubMed
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Reoperation after stapled hemorrhoidopexy is often needed for pain, bleeding, or fissures. While reintervention has risks, it effectively resolves symptoms for most patients, especially when performed by experienced colorectal surgeons.

Area of Science:

  • Colorectal Surgery
  • Surgical Outcomes
  • Gastroenterology

Background:

  • Stapled hemorrhoidopexy (Procedure for Prolapse and Hemorrhoids - PPH) is increasingly popular, often assumed to be less painful.
  • However, complications like persistent pain, tags, recurrence, and severe issues requiring surgery can occur.
  • This study analyzes causes and outcomes of reintervention after complicated or failed PPH.

Purpose of the Study:

  • To investigate the reasons for reoperation after stapled hemorrhoidopexy (PPH).
  • To evaluate the effectiveness and outcomes of reinterventions for complicated or failed PPH.
  • To identify common complications and necessary surgical procedures for reoperation.

Main Methods:

  • A retrospective analysis of 232 primary PPH and 65 reinterventions across five colorectal surgery centers.

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  • Patients undergoing reoperation had a mean age of 50, with indications including third- and fourth-degree hemorrhoids.
  • Clinical history review, physical examination, and proctoscopy were performed pre- and post-reintervention.

    • Main Results:

    • The reoperation rate after PPH was 11%.
    • Primary indications for reintervention included severe anal pain (45%), postoperative bleeding (31%), and anal fissure (21%).
    • Reintervention led to decreased pain (P < 0.001), with 80% showing no recurrence on proctoscopy.

    Conclusions:

    • Pain and bleeding, often due to piles, fissures, or retained staples, are key reasons for reoperation post-PPH.
    • Reintervention, despite a notable rate of bleeding and soiling, effectively treats pain and other symptoms in most patients.
    • Complex cases of failed or complicated PPH necessitate treatment by experienced colorectal surgeons due to the diverse range of required interventions.