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Persistent pain and faecal urgency after stapled haemorrhoidectomy
St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Surgery . Östergötlands Läns Landsting, Centre of Surgery and Oncology, Department of Surgery in Östergötland.
St Marks Hosp, Dept Surg, Harrow HA1 3UJ, Middx, England St Marks Hosp, Dept Physiol, Harrow HA1 3UJ, Middx, England John Radcliffe Hosp, Dept Colorectal Surg, Oxford OX3 9DU, England Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden.
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2000 (English)In: The Lancet, ISSN 0140-6736, Vol. 356, no 9231, 730-733 p.Article in journal (Refereed) Published
Abstract [en]

Introduction Haemorrhoidectomy usually cures haemorrhoids. Day surgery is feasible, and is associated with high patients' satisfaction and few complications, but patients take an average of 2 weeks off work after surgery. Stapled haemorrhoidectomy has the potential to decrease postoperative pain and time off work. However, data on longterm efficacy and function are lacking. Methods 22 patients underwent stapled haemorrhoidectomy: seven in a pilot study, and 15 in a randomised controlled trial to compare the new stapled operation with diathermy haemorrhoidectomy in a day-case setting. All operations were done by one consultant surgeon. Results 16 patients were followed up for longer than 6 months, five of whom (31% [95% CI 8.5-54.0%]) developed symptoms of pain and faecal urgency which persisted for up to 15 months postoperatively. The randomised trial was suspended, and patients were investigated with endoanal ultrasonography, anorectal physiology, and examination under anaesthetic. All five affected patients were reviewed by two independent surgeons experienced in the stapled operation. In one patient, a fibroepithelial polyp was found adjacent to an anodermal ulcer, in the other patients, no abnormality was found. Four of the five affected patients had some muscle incorporated into the doughnut, compared with only one of 11 of the unaffected patients (p=0.012, Fisher's exact test). No other significant differences in operative variables were identified between patients with and without symptoms, Interpretation Persistent severe pain and faecal urgency has been found in a disturbingly high proportion of patients after stapled haemorrhoidectomy. The mechanism behind this phenomenon is unclear, although muscle incorporation in the doughnut may have a role, Other groups who have studied stapled haemorrhoidectomy urgently need to audit their long-term results to assess the frequency of this problem.

Place, publisher, year, edition, pages
2000. Vol. 356, no 9231, 730-733 p.
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Medical and Health Sciences
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URN: urn:nbn:se:liu:diva-49620OAI: oai:DiVA.org:liu-49620DiVA: diva2:270516
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2011-01-14

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Nyström, Per-Olof

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