Zdravniški Vestnik (Dec 2003)

EARLY POSTOPERATIVE COMPLICATIONS AND RESULTS OF STAPLER HEMORRHOIDECTOMY (PPH)

  • Boštjan Mlakar,
  • Pavle Košorok,
  • Tine Velikonja

Journal volume & issue
Vol. 72, no. 0

Abstract

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Background. From January 2000 until May 2002 149 patients underwent stapled hemorrhoidectomy (PPH) at the Medical Centre IATROS. One day surgery was performed in spinal anaesthesia.Methods. We observed and analysed complications between 1 to 30 days after surgery. Long term follow-up ranged from 3 to 20 months. 76% of the patients returned the questionnaire we sent. The patients with complaints were reexamined.Results. Early postoperative complications (surgical and anaesthesiological) were observed in 41 patients (27.5%). Three patients (2%) were hospitalized: two because of bleeding and one because of pain and fever. No surgery was needed. External anal thrombosis occured in 2 cases (1.3%), 7 patients had pain after defecations (4.7%) and 8 patients (5.4%) had fever and/or eleveated body temperature. Patients with fever and/or elevated body temperature were treated five days with klindamicin. Urine retention occured in 12 patients (8.1%). Headache was a probleme in 9 patients (6%). The patients were satisfied with operation in 93% of the cases, partially satisfied in 1.8% and unsatisfied with result of the operation in 5.2%. 8% of patients had blood on paper after defecation, and we treated them with one or more rubber band ligations. Two of them required clasic hemorrhoidectomy. 6.2% of patients had pain after defecation and we treated them with anal dilatators. Anal stenosis occured in 2.6%. In these cases we pinched off some parts of the stenosing scar and recomended use of anal dilatators. Minor anal incontinence after operation was made worse in 6.2% and improved in 0.9%. 1.8% of patients had problem with urgent defecation.Conclusions. Our experience with one day surgery for PPH is good. We belive that this surgical procedure is an effective method for the third degree hemorrhoids. We do not recomend PPH when severe external piles are dominant and when large tags accompany the hemorrhoidal prolapse.Caution is necessary in performing PPH when any degree of anal incontinence is present. It could be the strething of the sphincter during the operatin the main reason that incontinence become worse.

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