[The Longo technique: should it be adopted?]

Complications of stapled hemorrhoidectomy: a French multicentric study

OBJECTIVES

The aim of this retrospective multicentric study was to assess the complications of the Longo technique for the treatment of haemorrhoidal disease.

METHODS

From March 1999 to April 2003, 550 patients underwent a stapled hemorrhoidectomy following Longo's technique in 12 surgical units in the Rhone-Alpes Region. The operative indications were the same as for conventional hemorrhoidectomy. Complications were divided into early or late complications depending on whether they occurred before or after the 7th day. For each patient, the most serious complication was retained for analysis.

RESULTS

One hundred and five patients (19%), mean age 51 years, experienced complications. The early complications were bleeding (1.8%), severe anal pain (2.3%), urinary retention (0.9%) and sepsis (0.5%). Late complications were chronic anal pain (1.6%), suture dehiscence (1.6%), anal stricture (1.6%), anal fissure (0.9%), external thrombosis (0.9%), fistulae and intramural abscesses (0.9%), anal incontinence (0.3%), haemorrhoidal disease symptoms persistence or recurrence (3.2%). Strictures were successfully dilated, fissures were treated by sphincterotomy, external thromboses were excised and fistulae were laid open. Most of the recurrences were treated with the Milligan-Morgan hemorroidectomy technique.

CONCLUSION

Complications may occur after stapled hemorrhoidopexy, some are particularly serious, especially bleeding and sepsis.

Complications après anopexie circulaire pour cure d’hémorroïdes : résultats à long terme d’une série de 140 malades et analyse de la littérature

AIM

The aim of this study was to determine the results and the complications of the treatment of hemorrhoids with circular stapler with a follow-up of 18 months, and to review the complications in the literature.

METHODS

From April 1998 to August 1999, 140 patients (83 males and 57 females) with an average age of 43.8 years (range: 19-83 years) underwent haemorrhoidectomy using a circular stapler in three university hospital centers. The degree of hemorrhoids has been classified: three cases of degree II, 97 cases of degree III, and 40 cases of degree IV. All the patients were prospectively evaluated at two weeks, two and 18 months after surgery.

RESULTS

The average length of the operation was 18 minutes (range: 8-60 minutes). Mean hospital stay was 36 hours (range: 8-72 hours). There was no intraoperative complication. There was no mortality. The postoperative complication rate was 7.8% (N = 11): there were five cases of bleeding that two complicated by a submucosal hematoma (one was infected and needed a rectotomy on day 21), two cases of urinary retention, and two cases of external hemorrhoid thrombosis. The bleeding occurred in the 12 hours after surgery except for one patient with antivitamin K whith presented a secondary bleeding on day 16. At 18 months, five patients presented a moderate asymptomatic stricture dilated on digital examination. Two patients complained of persistent skin tags. Neither functional trouble nor incontinence to gas, liquids, or solids was presented. With a mean follow-up of 40 months, 90% (N = 112) of the patients were fully satisfied.

CONCLUSIONS

Treatment of hemorrhoids with circular stapler appears to be effective with 96% of patients fully satisfied at 18 months. The morbidity rate was low, and no higher than the diathermy excision hemorrhoidectomy. The results are directly dependent on the practice that required a learning, and not on the technique itself.