| Reinterventions after complicated or failed stapled hemorrhoidopexy. | |
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MedLine Citation:
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PMID: 15622576 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Stapled hemorrhoidopexy has become increasingly popular over the past five years, mainly because of the assumption that it is associated with less pain. However, persistent tags and recurrence might represent a problem, because piles are not excised and severe complications requiring surgery have been occasionally reported. The aim of the present study is to analyze the causes for and the outcome of reintervention following either severely complicated or failed stapled hemorrhoidopexy. METHODS: A total of 232 primary stapled hemorrhoidopexies and 65 reinterventions after stapled hemorrhoidopexy were performed by the authors in five centers devoted to colorectal surgery. Twelve patients of the latter group had the stapled hemorrhoidopexy performed in one of these centers. Thirty-five were males and 30 were females. The mean age was 50 (range, 29-81) years. In all cases the primary indication for stapled hemorrhoidopexy was either third-degree or fourth-degree symptomatic hemorrhoids. In all patients submitted to reoperation the diagnosis of either severely complicated or failed stapled hemorrhoidopexy was made. The clinical history of all of these patients was carefully studied and all underwent inspection, digital exploration, and proctoscopy. After the reintervention, proctoscopy was performed in 61 patients (92 percent) after a median follow-up of 5.5 (range, 1-36) months. RESULTS: Our reoperation rate after stapled hemorrhoidopexy was 11 percent. The most frequent indications for reintervention were persistent, severe anal pain (visual analog pain score higher than 7) in 29 patients (45 percent), severe postoperative bleeding in 20 (31 percent), anal fissure in 16 (21 percent), prolapsing piles in 12 (18 percent), rectal polyp in 11 (16 percent), anorectal sepsis in 11 (16 percent), and fecal incontinence in 7 (11 percent). Thirteen different types of reintervention were needed. Excisional hemorrhoidectomy, removal of staples, and fissurectomy and/or internal sphincterotomy were the most frequent operation (n = 41). A decrease in anal pain, as measured by visual analog pain score, was observed one month after reintervention, compared with that measured preoperatively (from 5.6 +/- 3.6 to 3.0 +/- 2.9) (P < 0.001). Bleeding requiring treatment occurred in six cases (10 percent), anal stricture requiring dilation occurred in three (5 percent), and fecal incontinence in three (5 percent). Proctoscopy showed no recurrences in 52 cases (80 percent) after the reintervention. CONCLUSION: Pain and bleeding mostly caused by piles, fissures, and retained staples were the most frequent causes for reoperation after stapled hemorrhoidopexy. Reintervention was associated with a high bleeding and soiling rate, but was effective in treating pain and other symptoms in the majority of patients. Because of the wide spectrum of different interventions required, a failed or complicated stapled hemorrhoidopexy might be better treated by an experienced colorectal surgeon. |
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Authors:
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L Brusciano; S M Ayabaca; M Pescatori; G M Accarpio; G Dodi; F Cavallari; B Ravo; R Annibali |
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Publication Detail:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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Title: Diseases of the colon and rectum Volume: 47 ISSN: 0012-3706 ISO Abbreviation: Dis. Colon Rectum Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2004-12-28 Completed Date: 2005-02-01 Revised Date: 2006-06-06 |
Medline Journal Info:
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Nlm Unique ID: 0372764 Medline TA: Dis Colon Rectum Country: United States |
Other Details:
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Languages: eng Pagination: 1846-51 Citation Subset: IM |
Affiliation:
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Coloproctology Unit, Villa Flaminia Hospital, Rome, Italy. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Aged, 80 and over Chi-Square Distribution Female Fissure in Ano / etiology, surgery Hemorrhoids / surgery* Humans Male Middle Aged Pain, Postoperative / etiology, surgery Postoperative Complications / surgery* Postoperative Hemorrhage / etiology, surgery Reoperation Surgical Stapling / adverse effects* Treatment Outcome |
| Comments/Corrections | |
Comment In:
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Dis Colon Rectum. 2006 May;49(5):690-1; author reply 691-3
[PMID:
16489486
]
Dis Colon Rectum. 2006 May;49(5):693-4; author reply 694-5 [PMID: 16283560 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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