Proctitis after stapled hemorrhoidopexy is an underestimated complication of a widely used surgical procedure: a retrospective observational cohort study in 129 patients

Peter C Ambe,Dirk R Wassenberg

doi:10.1186/s13037-015-0081-6

Abstract

BackgroundHemorrhoidal disease is highly prevalent in the western world. Stapled hemorrhoidopexy also known as the procedure for prolapsed hemorrhoids (pph) has been shown to be superior to conventional hemorrhoidectomy with regard to postoperative pain, length of hospital stay and early return to work. Proctitis following stapled hemorrhoidopexy has not been reported previously. Herein, we report our experience with proctitis in patients following stapled hemorrhoidopexy and question if proctitis could be a complication of stapled hemorrhoidopexy.Materials and methodsA retrospective analysis of the data of patients undergoing stapled hemorrhoidopexy with the PPH03 in the coloproctology unit of the department of surgery of a primary care hospital in Germany within a 5-year period was performed. All cases were managed and followed up by a single attending surgeon with expertise in coloproctology.Results129 patients were included for analysis including 21 cases with grade 2, 103 cases of grade 3 and 5 cases of grade 4 hemorrhoids. The median duration of surgery was 20 min. 17 complications including two recurrences were recorded. Post-pph proctitis was recorded in 14 cases (10.9 %). Post-pph proctitis was not associated with gender, extent of hemorrhoidal disease, BMI and ASA (p >0.05). All cases recovered within 4 weeks following management with nonsteroidal anti-inflammatory drugs and suppositories.ConclusionProctitis could be a complication of stapled hemorrhoidopexy with a good response to conservative treatment with suppositories.

Highlights

Hemorrhoids are enlarged vascular cushions in the anal canal which become symptomatic secondary to engorgement or prolapse
Post-pph proctitis was not associated with gender, extent of hemorrhoidal disease, body mass index (BMI) and American Society of Anesthesiologists (ASA) (p >0.05)
Proctitis could be a complication of stapled hemorrhoidopexy with a good response to conservative treatment with suppositories

Summary

Introduction

Hemorrhoids are enlarged vascular cushions in the anal canal which become symptomatic secondary to engorgement or prolapse. The procedure was shown in a series of meta-analyses and systematic reviews to be safe and effective and to be superior to conventional hemorrhoidectomy with regard to postoperative pain and early return to work [12, 13]. In 2007 PPH was recommended by the National Institute for Health and Care Excellence (NICE) as an option for the surgical management of patients with prolapsed internal hemorrhoids [14] and has become an established procedure. Proctitis has not been previously reported as a complication of PPH. Stapled hemorrhoidopexy known as the procedure for prolapsed hemorrhoids (pph) has been shown to be superior to conventional hemorrhoidectomy with regard to postoperative pain, length of hospital stay and early return to work. We report our experience with proctitis in patients following stapled hemorrhoidopexy and question if proctitis could be a complication of stapled hemorrhoidopexy

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Discussion

Conclusion