Recurrence after stapled haemorrhoidopexy.

Abstract

The surgical procedure of stapled haemorrhoidopexy is now considered safe, and its reliability is improving with experience and technical upgrading. Compared to conventional procedures, the short-term advantages of stapled haemorrhoidopexy include less postoperative pain, faster recovery and healing, whereas the disadvantages of the procedure in the long term include an increased possibility of recurrent prolapse. The percentage of symptomatic prolapse after stapled procedures widely varies in the several clinical trials described in the literature, ranging between 2 and 53.3 % [1]. Many shortand long-term complications of the different treatments for haemorrhoids (conventional, stapled or realized with different new devices) have been reported in the literature [2]. Less evidence is available about how to minimize these undesirable effects of stapling procedures, and there are no studies that describe and classify recurrences and the strategies to deal with them. We performed a retrospective study on 69 patients with recurrent prolapse after stapled haemorrhoidopexy [58 patients treated with a single-stapled procedure and 11 with a double-stapled procedure for prolapse and haemorrhoids (DSPPH)] who underwent re-intervention for recurrence. Prolapse over half of the circular anal dilator (CAD) is usually treated with a double stapling technique [3]. Thirty-five patients were female, and 34 were male. The mean age was 50 years (range 25–74 years). The follow-up was performed in the outpatient clinic at 1 week, 4 weeks and 6 months after surgery and yearly thereafter. The mean time until recurrence was 18 months (range 2–42 months) in the 58 patients, who had undergone a procedure for prolapse and haemorrhoids (PPH), and 12 months (range 2–42 months) in those who had undergone a DSPPH. The clinical onset of recurrence and the operations chosen are shown in Table 1. In the group of patients treated with PPH or DSPPH, bleeding requiring surgical revision occurred in one patient. Minor bleeding, managed with a local haemostatic device, was reported by one patient. In the patients treated with surgical excision, instead, bleeding occurred in one patient and required surgical revision. Urgency (n = 2) and anal pain (n = 2), which occurred in patients in both groups, spontaneously disappeared after surgery. In the patients who underwent surgical excision combined with PPH, no bleeding, urgency or persisting anal pain occurred. The mean follow-up after reoperative surgery lasted 40 months (range 23–96 months). No cases of second recurrence occurred. In the case of a mobile prolapse, this may be resected with stapler (PPH or DSPPH, depending on the amount of the prolapse that needs to be resected). On the contrary, in the case of a fixed prolapse, one or two piles, the choice should be surgical excision. In case of more than three multiple piles (C3), transrectal resection with a stapler (PPH or DSPPH) may be used. A PPH combined with Milligan–Morgan haemorrhoidectomy should be applied in & D. Pironi danielepironi@gmail.com