Predisposing and aetiologic factors for haemorrhoidal recurrence after procedure for prolapse and haemorrhoids (PPH)

Abstract

The procedure for prolapse and haemorrhoids (PPH) is widely accepted as safe and effective for haemorrhoidal disease (HD). Unsatisfactory outcomes concern post PPH symptoms and need for reintervention. A review of the updated literature to December 2014 was performed regarding post PPH recurrence. Post PPH recurrence rates range from 2% to 25.9% (7.7% on meta-analysis) and reoperation rates for recurrence are between 3.4% and 18%. Residual or recurrent prolapse after PPH is attributed to incorrect indication for surgery, insufficient resection, and technical errors mostly arising during the purse-string phase of the procedure. If symptomatic, recurrent or persisting prolapse is usually alleviated by repeat PPH; in fixed and irreducible prolapse, conventional haemorrhoidectomy is preferred. Technique modifications and new devices in order to reduce post PPH recurrence need further validation. To minimize post PPH recurrence, strict inclusion criteria and well-performed primary surgery, calibrated on the sufficient amount of prolapse resected, and occasionally combined with excision of residual haemorrhoids, should be demanded. If the condition is symptomatic, recurrent or persisting prolapse is treated with repeat PPH when it is mobile and uniform, and with conventional haemorrhoidectomy when it is irreducible.