Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line

Menconi, Claudia; Fabiani, Bernardina; Giani, Iacopo; Martellucci, Jacopo; Toniolo, G. Chechile; Naldini, Gabriele

doi:10.1007/s00384-015-2355-y

Cited by 12 publications

(3 citation statements)

References 13 publications

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“…In case of chronic pelvic pain after stapler surgery, the removal of staples or staple line excision has been reported [106,190]. However, the evidence of these treatments is low and effectiveness observed only in a low percentage of patients.…”

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confidence: 99%

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

et al. 2020

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Hemorrhoidal disease (HD) is the most common proctological disease in the Western countries. However, its real prevalence is underestimated due to the frequent self-medication. The aim of this consensus statement is to provide evidence-based data to allow an individualized and appropriate management and treatment of HD. The strategy used to search for evidence was based on application of electronic sources such as MEDLINE, PubMed, Cochrane Review Library, CINAHL, and EMBASE. These guidelines are inclusive and not prescriptive. The recommendations were defined and graded based on the current levels of evidence and in accordance with the criteria adopted by American College of Chest Physicians. The recommendations were graded A, B, and C.

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confidence: 99%

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

et al. 2020

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“…There was not any new onset of perioperative anal incontinence with FISI score of 0. Persistent anal pain rate was 1.7% caused by a rigid suture fixed on the deep planes at the level of puborectalis muscle ad it was quickly treated (within 6 months as already reported) [21] removing tracts of a rigid suture with a complete symptoms resolution thereafter.…”

Section: Postoperative Complicationsmentioning

confidence: 72%

Long-term outcomes of high-volume stapled hemorroidopexy to treat symptomatic hemorrhoidal disease

et al. 2023

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The study aimed to assess the long-term results of the stapled hemorrhoidopexy (SH) using high-volume devices equipped with innovative technology, evaluating recurrence rate, complications rate, and patients' satisfaction. Methods: All the patients who underwent SH using high-volume devices (TST Starr plus, Touchstone International Medical Science Corp., Ltd.) for II to IV symptomatic hemorrhoidal disease from November 2012 to December 2014 were enrolled. Between December 2019 and January 2020, all of them were phone called to come to undergo a proctological reevaluation and asked to fill some questionnaires about hemorrhoidal prolapse recurrence, symptoms recurrence, and surgery satisfaction. Results: Fifty-nine patients with a mean age of 47 years completely answered the questionnaires. Twenty-two of them accepted to come to undergo a proctological reevaluation while 27 preferred to answer only by phone due to their referred wellbeing. The median follow-up was 70.5 months (range, 60-84 months). The recurrence rate was 5.1% with a mean satisfaction level after surgery was 9.1 (range, 0-10) and 84.7% of patients whose satisfaction scored ≥ 8. The mean value of Cleveland Global Quality of Life assessment was 0.79 (range, 0.71-0.93). There were no cases of new onset of impaired anal continence after surgery. Conclusion: The new generation high-volume devices to perform SH resulted to be safe and effective for II to IV degree hemorrhoidal prolapse leading to a lower long-term recurrence rate with an evident reduction of postoperative complications in comparison with the low-volume SH.

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“…Short-term postoperative complications were recorded during hospitalization: the frequency of additional injected postoperative analgesics were counted (0 indicating no unbearable pain and 1 indicating unbearable pain), and the patients' postoperative pain was recorded at seven time points after the operation (Day 1, Day 2, Day 3, Day 4, Day 5, Day 6, and Day 7), as assessed by the NRS score [0 indicating no pain and 10 indicating the worst pain ( 14 , 15 )].…”

Section: Methodsmentioning

confidence: 99%

Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids

et al. 2022

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ObjectiveTissue selection therapy staplers (TSTs) are widely used to treat prolapsing hemorrhoids; however, some disadvantages exist. We describe a modified technique for the treatment of prolapsing hemorrhoids, with the aim of minimizing the risk of anal stenosis and anal incontinence and reducing the impact of postoperative complications from the stapling technique. We applied a modified TST procedure, and the preliminary data were used to test the efficacy and safety of this new technique.MethodsWe conducted a retrospective study of patients who underwent modified TST for prolapsing hemorrhoids at our department between January 2018 and January 2020. All patients received a modified TST. Most prolapsing hemorrhoids were not segmentally resected and were instead selectively removed. The demographics, preoperative characteristics, postoperative complications, therapeutic effects, and patient satisfaction were collected and analyzed.ResultsA total of 106 patients were included in the study; 53 were men and 53 women (mean age, 49.24 years). The mean operative time was 55.01 min, and the mean hospital stay was 7.82 days. After surgery, three patients experienced bleeding (2.83%), 2 patients experienced anal discharge (1.89%), 2 patients experienced tenesmus (1.89%), and 5 patients experienced anal tags (4.72%). Anal incontinence, persistent post stapler pain, rectovaginal fistula and anal stenosis did not occur. Two patients developed recurrent symptomatic hemorrhoids (1.89%). The total effective rate of the surgery and the total satisfaction rate of the patients was 97.17%.ConclusionsThe modified tissue selection therapy stapler technique was a satisfactory and economical treatment for prolapsing hemorrhoids at a follow-up period of 1 year. The modified TST was associated with reduced anal stenosis and anal incontinence, less persistent post stapler pain and a minimal risk of rectovaginal fistula.

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Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line

Abstract: The relief of PAP after stapled procedure, in which we recognize a scarred and fixed staple line, depends by the early recognition of this typical finding. The authors suggest the surgical treatment not later than 3-6 months after the onset of symptoms to achieve the best results.

Cited by 12 publications

References 13 publications

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of hemorrhoidal disease

Long-term outcomes of high-volume stapled hemorroidopexy to treat symptomatic hemorrhoidal disease

Outcomes of Modified Tissue Selection Therapy Stapler in the Treatment of Prolapsing Hemorrhoids

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