EARLY POSTOPERATIVE COMPLICATIONS AND RESULTS OF STAPLER HEMORRHOIDECTOMY (PPH)
Abstract
Background. From January 2000 until May 2002 149 patients underwent stapled hemorrhoidectomy (PPH) at the Medical Centre IATROS. One day surgery was performed in spinal anaesthesia.
Methods. We observed and analysed complications between 1 to 30 days after surgery. Long term follow-up ranged from 3 to 20 months. 76% of the patients returned the questionnaire we sent. The patients with complaints were reexamined.
Results. Early postoperative complications (surgical and anaesthesiological) were observed in 41 patients (27.5%). Three patients (2%) were hospitalized: two because of bleeding and one because of pain and fever. No surgery was needed. External anal thrombosis occured in 2 cases (1.3%), 7 patients had pain after defecations (4.7%) and 8 patients (5.4%) had fever and/or eleveated body temperature. Patients with fever and/or elevated body temperature were treated five days with klindamicin. Urine retention occured in 12 patients (8.1%). Headache was a probleme in 9 patients (6%). The patients were satisfied with operation in 93% of the cases, partially satisfied in 1.8% and unsatisfied with result of the operation in 5.2%. 8% of patients had blood on paper after defecation, and we treated them with one or more rubber band ligations. Two of them required clasic hemorrhoidectomy. 6.2% of patients had pain after defecation and we treated them with anal dilatators. Anal stenosis occured in 2.6%. In these cases we pinched off some parts of the stenosing scar and recomended use of anal dilatators. Minor anal incontinence after operation was made worse in 6.2% and improved in 0.9%. 1.8% of patients had problem with urgent defecation.
Conclusions. Our experience with one day surgery for PPH is good. We belive that this surgical procedure is an effective method for the third degree hemorrhoids. We do not recomend PPH when severe external piles are dominant and when large tags accompany the hemorrhoidal prolapse.
Caution is necessary in performing PPH when any degree of anal incontinence is present. It could be the strething of the sphincter during the operatin the main reason that incontinence become worse.
Downloads
References
Longo A. Treatment of hemorrhoids disease by reduction of mucosa and hemorrhoidal prolapse with circular suturing device: a new procedure. Sixth World Congress of Endoscopic Surgery, Rome, Italy. Bologna: Monduzzi Publishing Co, 1998: 777–84.
Mehigan BJ, Monson JR, Hartley JE. Stapling procedure for hemorrhoids versus Milligan-Morgan hemorrhoidectomy: randomized controlled trial. Lancet 2000; 355: 782–5.
Rowsell M, Bello M, Hemingway DM. Circumferential mucosectomy (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy: randomized controlled trial. Lancet 2000; 355: 779–81.
Ho YH, Cheong WK, Tsang C et al. Stapled hemorrhoidectomy-cost and effectiveness. Randomised controlled trial including incontinence scoring, anorectal manometry, and endoanal ultrasound assessments at up to three months. Dis Colon Rectum 2000; 43: 1666–76.
Singer MA et al. Early experience with stapled hemorrhoidectomy in the United States. Dis Colon Rectum 2002; 45: 360–9.
Monson JRT. Invited commentary. Dis Colon Rectum 2002; 45: 367–9.
Molly RG, Kingsmore D. Life threatening pelvic sepsis after stapled haemorrhoidectomy. Lancet 2000; 355: 810–0.
Carapeti E, Kamm M, McDonald P, Phillips R. Double blind randomised controlled trial of effect of metronidazol on pain after day-case hemorrhoidectomy. Lancet 1998; 351: 169–72.
Balfour L et al. A randomized, double blind trial of effect of metronidazol on pain after closed hemorrhoidectomy. Dis Colon Rectum 2002; 45: 1186–91.
Pernice LM et al. Early and late experience with circular stapler hemorrhoidectomy. Dis Colon Rectum 2001; 44: 836–41.
Farinetti A, Saviano M, Quaranta N, Monni S. Surgical treatment of hemorrhoidal disease using the circular stapler. Analysis of 60 operated cases. Minerva Chir 2001; 56: 125–31.
Cheetham MJ, Mortensen NJ, Nystrom PO, Kamm MA, Phillips RK. Persistent pain and faecal urgency after stapled hemorrhoidectomy. Lancet 2000; 26: 730–3.
Gordon PH. Anal incontinence. In: Gordon PH, Nivatvongs S eds. Principles and practice of surgery for the colon, rectum and anus. 2nd ed. St. Louis, Missouri: Quality Medical Publishing, 1999: 367–8.
Friediger J et al. Results of hemorrhoidectomy using the Longo techniquepreliminary report. Proktologia 2002; 3: 30–9.
Paran H et al. Treatment of hemorrhoids with stapled circumferential mucosectomy: experience of our institution. Joint Meeting of M.S.C.P. and T.A.C.S. and 9th Turkish National Congress of Colorectal Surgery, Antalya, Turkey. Antalya: Turkish Association of Colorectal Surgeons, 2001: 81–1.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
