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

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.

Manejo quirúrgico de hemorroides internas en un centro de referencia de Manizales del 2010 al 2017

“…La hemorroidectomía y la hemorroidopexia presentan entre el 3% y el 12% de complicaciones posoperatorias y las más comunes son: retención urinaria, dolor local, sangrado, estenosis anal, incontinencia anal, fístula PPH -Procedimiento de Prolapso Hemorroidal) (18,(31)(32)(33)(34), Las complicaciones infecciosas son inferiores al fístulas, retención urinaria, estenosis ni proctitis. Se evidenciaron 3 casos de complicaciones por sangrado (el 3.2% de los casos estudiados), lo que concuerda con lo reportado en la literatura: el riesgo de hemorragia postoperatoria (inmediato, temprano, o retardado) es de aproximadamente 2% ( 35), e incluso puede ser de alrededor del 4.2% para otros autores (13).…”

“…Las técnicas innovadoras con grapado como el Procedimiento de Prolapso Hemorroidal (PPH) tienen una ventaja aparente sobre otras técnicas no convencionales como la pinza bipolar o el bisturí armónico, ya que se realizan por encima de la línea dentada, dentro del canal anal, afectando pocas terminaciones nerviosas, y realizando a la vez una pexia a la mucosa con recuperación más rápida (15)(16)(17)(18). Sin embargo, los estudios no han demostrado una complicaciones, si se comparan ambas técnicas (17,18).…”

“…Resultados posoperatorios comparativos con las diferentes técnicas quirúrgicas tratamiento quirúrgico, es decir, para el grado II, III, IV(4,18).…”