Stenosis After Stapled Anopexy: Personal Experience and Literature Review

Abstract

Purpose: Post-operative stenosis following SA is a rare complication, however it can be strongly disabling and require further treatments. Objective of the study is to identify risk factors and procedures of treatment of stenosis after Stapled Anopexy. Methods: 237 patients subjected to surgical resection with circular stapler for symptomatic III-IV-degree haemorrhoids without obstructed defecation disorders. 225 cases (95%) respected the planned follow-up conduced for one year after surgery. Results: Stenosis was noticed in 23 patients (10.2%), 7 of which (3,1%) complained about "difficult evacuation". All patients reported symptomatology appearance within 60 days from surgery. Previous rubber band ligation was referred from 7 patients (30,43%) and painful post-operative course (VAS >6) was referred from 11 (47,82%) of the 23 that developed a stenosis. These values appear statistically significant with p<0.05. Previous anal surgery and number of stitches applied during surgical procedure do not appear statistically significant. Symptomatic stenosis was subjected to cycles of outpatient progressive dilatation with remission of troubles in six cases. A woman, did not get any advantage, was been subjected to surgical operation, removing the stapled line and performing a new handmade sutura. Conclusions: The stenosis that complicate Stapled Anopexy are high anal stenosis or low rectal stenosis and they are precocious, reported within 60 days from surgery. If intense post-operative pain occurs (VAS >6), this appears to be related to development of a symptomatic stenosis. Surgery is avoidable in most cases and conservative treatment, as outpatient dilatations, has to be carried out.

Association of Muscle Fibers with Histopathology in Doughnut Specimens Following Stapled Hemorrhoidopexy and Their Impacts on Postoperative Outcomes

“… 24 The incidence of stenosis after stapled hemorrhoidopexy ranges from 0 to 8%, and most cases resolve with conservative management (i.e., outpatient dilatation), rarely requiring surgical intervention. 25 In this study, we found that the rate of recurrence was 3%, the rate of incontinence was 2%, and the rate of stenosis was less than 1.5%. When comparing Group A with Group B, the results were statistically insignificant.…”

House advancement flap anoplasty in anal stenosis post hemorrhoids surgery. A case report

“…An intriguing hypothesis states that stenosis results from micro-dehiscences of the suture line, which are followed by a submucosa phlogosis and the creation of retractile scar tissue. Undoubtedly, stenosis can be caused by improper suture placement, too low and/or large removal of hemorrhoidal tissue, or asymmetrical, too deep, or more appropriately, at full thickness [13] .…”