Rectal lumen obliteration from stapled hemorrhoidopexy: can it be prevented?

Stapled hemorrhoidopexy is an operation that is widely used and accepted as a standard procedure by many surgery clinics as the postoperative pain is minimal, period needed for return to work and social life is short and recurrence rate is acceptable. However, stapled hemorrhoidopexy may also result in some major complications. An important proportion of these complications (such as anastomosis dehiscence, rectovaginal fistula, anorectal stricture and rectal obstruction) occur due to the errors of purse string suture technique. In this report, we present a case of rectal obstruction following stapled hemorrhoidopexy in a 27-year-old female patient with fourth grade hemorrhoidal disease and want to draw the attention to the probable ways by which rectal obstruction can occur due to this surgical method. The complication that occurred was related to a purse string suture that also crossed an internal rectal prolapse. Paying attention to the technique of purse string placement during the procedure, placing purse string sutures 3-4 cm proximal to the dentate line with intervals of 1-1.5 cm, verifying the existence of a lumen before introducing the stapler and just including the rectal mucosa will minimize the risk of complications.