Complications after stapled hemorrhoidectomy: Can they be prevented?

被引：117

作者：

Ravo B. ^{[1
]}

Amato A. ^{[2
]}

Bianco V. ^{[3
]}

Boccasanta P. ^{[4
]}

Bottini C. ^{[5
]}

Carriero A. ^{[6
]}

Milito G. ^{[7
]}

Dodi G. ^{[8
]}

Mascagni D. ^{[9
]}

Orsini S. ^{[10
]}

Pietroletti R. ^{[11
]}

Ripetti V. ^{[12
]}

Tagariello G.B. ^{[13
]}

机构：

[1] Rome American Hospital, I-00155 Rome

[2] UCP-Policlinico, Milan

[3] Gallerate, Milan

[4] Tor Vergata University, Rome

[5] La Sapienza University, Rome

[6] UCP-S.S. Trinità Hospital, Sora (FR)

[7] UCP-CampusBioMedico, Rome

来源：

Techniques in Coloproctology | 2002年 / 6卷 / 2期

关键词：

Anatomy; Anus; Circular stapler; Complications; Hemorrhoids;

D O I：

10.1007/s101510200018

中图分类号：

学科分类号：

摘要：

Stapled hemorrhoidectomy (SH), a new approach to the treatment of hemorrhoids, removes a circumferential strip of mucosa about four centimeters above the dentate line. A review of 1107 patients treated with SH from twelve Italian coloproctological centers has revealed a 15% (164/1107) complication rate. Immediate complications (first week) were: severe pain in 5.0% of all patients, bleeding (4.2%), thrombosis (2.3%), urinary retention (1.5%), anastomotic dehiscence (0.5%), fissure (0.2%), perineal intramural hematoma (0.1%), and submucosal abscess (0.1%). Bleeding was treated surgically in 24%, with Foley insertion in 15%, and by epinephrine infiltration in 2%; 53% of patients with bleeding received no treatment and 6% needed transfusion. One patient with anastomotic dehiscence needed pelvic drainage and colostomy formation. The most common complication after 1 week was recurrence of hemorrhoids in 2.3% of patients, severe pain (1.7%), stenosis (0.8%), fissure (0.6%), bleeding (0.5%), skin tag (0.5%), thrombosis (0.4%), papillary hypertrophy (0.3%), fecal urgency (0.2%), staples problems (0.2%), gas flatus and fecal incontinence (0.2%), intramural abscess, partial dehiscence, mucosal septum and intussusception (each <0.1%). Recurrent hemorrhoids were treated by ligation in 40% and by Milligan-Morgan procedure in 32%. All hemorrhoidal thromboses were excised. Anal stenoses were treated by dilatation in 55% and by anoplasty in 45%. Fissure was treated by dilatation in 57%. Most complications (65%) occurred after the surgeon had more than 25 case experiences of stapled hemorrhoidectomy. The most common complication in the first 25 cases of the surgeon's experience was bleeding (48%). Even though SH appears to be promising, we feel that a multicenter randomized study with a long-term follow-up comparing SH and banding is necessary before recommending the procedure. Most complications can be avoided by respecting the rectal wall anatomy in the execution of the procedure.

引用

页码：83 / 88

页数：5

共 27 条

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