Life threatening pelvic sepsis after stapled haemorrhoidectomy

doi:10.1016/S0140-6736(00)02208-X

The Lancet

Volume 355, Issue 9206, 4 March 2000, Page 810

https://doi.org/10.1016/S0140-6736(00)02208-X Get rights and content

Summary

We describe a case of severe retroperitoneal sepsis after stapled haemorrhoidectomy. The operation seemed to be technically satisfactory, and we suggest that routine antibiotic prophylaxis may be indicated with this procedure.

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Cited by (250)

Hemorrhoids and Rectoceles
2019, Shackelford's Surgery of the Alimentary Tract: 2 Volume Set
There are few diseases more chronicled in human history than symptomatic hemorrhoidal disease. Most hemorrhoidal complaints can be managed nonoperatively. Symptomatic internal hemorrhoids typically cause rectal bleeding, while external hemorrhoids typically cause thrombosis and pain. Physicians should be familiar with several different techniques to address hemorrhoidal complaints. These include office-based procedures, excisional hemorrhoidectomy, and newer techniques such as Doppler-guided hemorrhoid artery ligation. A rectocele occurs when the pelvic floor and rectovaginal septum becomes so weak that the rectum bulges forward onto the posterior wall of the vagina. The diagnosis and treatment of rectoceles requires a multidisciplinary approach, and nonoperative therapy includes the correction of constipation and biofeedback. Surgical repairs can be made with either a transrectal or transvaginal incision, with the latter having the best long-term outcomes.
Circular mucosal anopexy: Experience and technical considerations
2016, Cirugia Espanola
La anopexia mucosa circular (AMC) condiciona un postoperatorio menos molesto que las técnicas resectivas, pero no está exenta de complicaciones y presenta una mayor recidiva. El objetivo del presente estudio es evaluar la eficacia de la AMC en el tratamiento de las hemorroides y del prolapso mucoso rectal (PMR).
Entre 1999 y 2011 fueron intervenidos en nuestro hospital 613 pacientes por hemorroides o PMR: en 327 casos se realizó AMC (PMR en 28 casos, grado II en 46, grado III en 146 y grado IV en 107 casos). La AMC se realizó en régimen de cirugía mayor ambulatoria (CMA) en el 79% de los casos. Consideramos la recidiva y comparamos los grupos de no recidiva y recidiva. Evaluamos el dolor medido por Escala Visual Analógica (EVA) y las complicaciones postoperatorias.
En 31 pacientes se registró recidiva de la sintomatología que precisó algún tipo de intervención: PMR en 5 pacientes, grado II en 2, grado III en 17 y grado IV en 7. No existieron diferencias significativas entre los pacientes con reccidiva y los pacientes sin recidiva en cuanto a género, tiempo operatorio ni grado hemorroidal, pero sí respecto a la edad. El 81,3% de los pacientes expresó dolor ≤ 2 en EVA a la semana. Cinco pacientes se reintervinieron por sangrado postoperatorio inmediato. Seis pacientes precisaron ingreso por dolor postoperatorio.
La recidiva en la AMC es superior a la de las técnicas resectivas. La AMC es una técnica útil para el tratamiento de la enfermedad hemorroidal en régimen de CMA. El grado de dolor y las complicaciones son bajos.
Circular mucosal anopexy (CMA) achieves a more comfortable postoperative period than resective techniques. But complications and recurrences are not infrequent. This study aims to evaluate of the efficacy of CMA in the treatment of hemorrhoids and rectal mucosal prolapse (RMP).
From 1999 to 2011, 613 patients underwent surgery for either hemorrhoids or RMP in our hospital. CMA was performed in 327 patients. Gender distribution was 196 male and 131 female. Hemorrhoidal grades were distributed as follows: 28 patients had RMP, 46 2nd grade, 146 3rd grade and 107 4th grade. Major ambulatory surgery (MAS) was performed in 79.9%. Recurrence of hemorrhoids was studied and groups of recurrence and no-recurrence were compared. Postoperative pain was evaluated by Visual Analogical Scale (VAS) as well as early complications.
A total of 31 patients needed reoperation (5 RMP, 2 with 2nd grade, 17 with 3rd grade,/with 4th grade). No statistically significant differences were found between the non-recurrent group and the recurrent group with regards to gender, surgical time or hemorrhoidal grade, but there were differences related to age. In the VAS, 81.3% of patients expressed a postoperative pain ≤ 2 at the first week. Five patients needed reoperation for early postoperative bleeding. Six patients needed admission for postoperative pain.
Recurrence rate is higher in CMA than in resective techniques. CMA is a useful technique for the treatment of hemorrhoids in MAS. Pain and the rate of complications are both low.
Reoperative surgery for complications of hemorrhoidectomy
2015, Seminars in Colon and Rectal Surgery
Citation Excerpt :
These complications have been managed conservatively with antibiotics and supportive treatment.32 They have also required exploratory laparotomy with fecal diversion and pelvic drainage.33,34 The etiology of sepsis following hemorrhoid surgery is unknown but may be due to incorporation of the full thickness of the rectal wall into the pursestring and subsequently the stapler.
Hemorrhoids remain among the most common disorders treated by colorectal surgeons. A wide variety of medical, office-based, and surgical treatment options are currently available. The primary surgical procedures from which patients and surgeons may choose include excisional hemorrhoidectomy, stapled hemorrhoidopexy, and transanal hemorrhoidal dearterialization. Each of these operations is safe, however, like all operations, carry certain risks of complications. Some of these complications may require surgical management. Pain is the most common complication of hemorrhoid procedures. This is most often management non-operatively; however, pain can be secondary to an abscess, thrombosis, or retained staples, which may require surgical management. Postoperative bleeding can occur due to uncontrolled vascular inflow, dehiscence of closed hemorrhoidectomy wounds, or bleeding at the staple line. Stricture is a complication of excisional hemorrhoidectomy that may require anoplasty with flap reconstruction.
Colonization of multidrug-resistant Gram-negative bacteria increases risk of surgical site infection after hemorrhoidectomy: a cross-sectional study of two centers in southern China
2023, International Journal of Colorectal Disease
Current Methods in The Surgical Treatment of Hemorrhoids
2023, Research Square
Transanal open haemorrhoidopexy: a well-tolerated, minimally invasive surgical method for haemorrhoids grade II to IV
2023, ANZ Journal of Surgery

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Research LettersLife threatening pelvic sepsis after stapled haemorrhoidectomy

Summary

Treatment of external anorectal mucosal prolapse with circular stapler: an easy and effective new surgical treatment

Dis Colon Rectum

Septic complications of haemorrhoidal banding

Arch Surg

Research Letters
Life threatening pelvic sepsis after stapled haemorrhoidectomy