You have full access to this open access article. Procedure for prolapsing hemorrhoids PPH and stapled transanal rectal resection for obstructed defecation STARR carry low postoperative pain, but may be followed by unusual and severe postoperative complications.
This review deals with the pathogenesis, prevention and treatment of adverse events that may occasionally be life threatening. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma and perforation with pelvic sepsis often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for fourth-degree piles.
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However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented.
Stapled transanal mucosectomy, first experimented at our unit [ 1 ], aims to treating rectal internal mucosal prolapse and obstructed defecation. The technique was later proposed by Longo [ 2 ] for the treatment of hemorrhoids. Subsequently called stapled hemorrhoidopexy or procedure for prolapsed hemorrhoids PPH , the technique gained a wide popularity due to the low postoperative pain [ 3 , 4 ].
Almost all studies, with a few exceptions [ 5 , 6 ], also found an early return to work. Recently, a systematic review [ 7 ] and a Cochrane meta-analysis [ 8 ] showed that the recurrence rate after PPH is higher than that after manual hemorrhoidectomy 5. Both the systematic review as well as the practice parameters of the American Society of Colon and Rectal Surgeons [ 9 ] mention the rare occurrence of potentially devastating complications after PPH.
