Obstructed defecation after stapled hemorrhoidopexy: A report of four cases

Jacob E. Dowden, John Stanley, Richard A. Moore

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Stapled hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids (PPH) has become an accepted alternative to excisional hemorrhoidectomy for treating prolapsing hemorrhoids. Although rare, severe complications have been reported after this procedure. We report a series of four male patients with the unusual but debilitating symptoms of obstructed defecation (OD) after PPH. Presenting symptoms included evacuation difficulty, rectal pain, and urgency. All had scarring and stenosis at their PPH anastomotic staple line with a resultant ball-valve effect in three patients as the mobile, excessive, proximal rectal mucosa prolapsed past this relatively immobile area. The fourth patient had an anterior rectal mucosal pouch distal to the PPH staple line. In three of the four patients the anastomosis was below the dentate line or on an oblique angle. Corrective operative intervention largely relieved OD symptoms. One patient, more refractory to successful revision, was eventually diagnosed and treated successfully for pudendal neuropathy. Avoidance of the complication of OD is possible through careful patient selection, proper operative technique, and consideration of nonsurgical etiologies. These complications are complex in nature but most patients will respond to an individualized treatment plan that combines surgical and medical interventions.

Original languageEnglish (US)
Pages (from-to)622-625
Number of pages4
JournalAmerican Surgeon
Volume76
Issue number6
StatePublished - Jun 1 2010

Fingerprint

Defecation
Hemorrhoids
Prolapse
Pudendal Neuralgia
Hemorrhoidectomy
Patient Selection
Cicatrix
Pathologic Constriction
Mucous Membrane
Pain

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Obstructed defecation after stapled hemorrhoidopexy : A report of four cases. / Dowden, Jacob E.; Stanley, John; Moore, Richard A.

In: American Surgeon, Vol. 76, No. 6, 01.06.2010, p. 622-625.

Research output: Contribution to journalArticle

Dowden, Jacob E. ; Stanley, John ; Moore, Richard A. / Obstructed defecation after stapled hemorrhoidopexy : A report of four cases. In: American Surgeon. 2010 ; Vol. 76, No. 6. pp. 622-625.
@article{917fdae6ba3646a695ac09a25553da99,
title = "Obstructed defecation after stapled hemorrhoidopexy: A report of four cases",
abstract = "Stapled hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids (PPH) has become an accepted alternative to excisional hemorrhoidectomy for treating prolapsing hemorrhoids. Although rare, severe complications have been reported after this procedure. We report a series of four male patients with the unusual but debilitating symptoms of obstructed defecation (OD) after PPH. Presenting symptoms included evacuation difficulty, rectal pain, and urgency. All had scarring and stenosis at their PPH anastomotic staple line with a resultant ball-valve effect in three patients as the mobile, excessive, proximal rectal mucosa prolapsed past this relatively immobile area. The fourth patient had an anterior rectal mucosal pouch distal to the PPH staple line. In three of the four patients the anastomosis was below the dentate line or on an oblique angle. Corrective operative intervention largely relieved OD symptoms. One patient, more refractory to successful revision, was eventually diagnosed and treated successfully for pudendal neuropathy. Avoidance of the complication of OD is possible through careful patient selection, proper operative technique, and consideration of nonsurgical etiologies. These complications are complex in nature but most patients will respond to an individualized treatment plan that combines surgical and medical interventions.",
author = "Dowden, {Jacob E.} and John Stanley and Moore, {Richard A.}",
year = "2010",
month = "6",
day = "1",
language = "English (US)",
volume = "76",
pages = "622--625",
journal = "American Surgeon",
issn = "0003-1348",
publisher = "Southeastern Surgical Congress",
number = "6",

}

TY - JOUR

T1 - Obstructed defecation after stapled hemorrhoidopexy

T2 - A report of four cases

AU - Dowden, Jacob E.

AU - Stanley, John

AU - Moore, Richard A.

PY - 2010/6/1

Y1 - 2010/6/1

N2 - Stapled hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids (PPH) has become an accepted alternative to excisional hemorrhoidectomy for treating prolapsing hemorrhoids. Although rare, severe complications have been reported after this procedure. We report a series of four male patients with the unusual but debilitating symptoms of obstructed defecation (OD) after PPH. Presenting symptoms included evacuation difficulty, rectal pain, and urgency. All had scarring and stenosis at their PPH anastomotic staple line with a resultant ball-valve effect in three patients as the mobile, excessive, proximal rectal mucosa prolapsed past this relatively immobile area. The fourth patient had an anterior rectal mucosal pouch distal to the PPH staple line. In three of the four patients the anastomosis was below the dentate line or on an oblique angle. Corrective operative intervention largely relieved OD symptoms. One patient, more refractory to successful revision, was eventually diagnosed and treated successfully for pudendal neuropathy. Avoidance of the complication of OD is possible through careful patient selection, proper operative technique, and consideration of nonsurgical etiologies. These complications are complex in nature but most patients will respond to an individualized treatment plan that combines surgical and medical interventions.

AB - Stapled hemorrhoidopexy or Procedure for Prolapse and Hemorrhoids (PPH) has become an accepted alternative to excisional hemorrhoidectomy for treating prolapsing hemorrhoids. Although rare, severe complications have been reported after this procedure. We report a series of four male patients with the unusual but debilitating symptoms of obstructed defecation (OD) after PPH. Presenting symptoms included evacuation difficulty, rectal pain, and urgency. All had scarring and stenosis at their PPH anastomotic staple line with a resultant ball-valve effect in three patients as the mobile, excessive, proximal rectal mucosa prolapsed past this relatively immobile area. The fourth patient had an anterior rectal mucosal pouch distal to the PPH staple line. In three of the four patients the anastomosis was below the dentate line or on an oblique angle. Corrective operative intervention largely relieved OD symptoms. One patient, more refractory to successful revision, was eventually diagnosed and treated successfully for pudendal neuropathy. Avoidance of the complication of OD is possible through careful patient selection, proper operative technique, and consideration of nonsurgical etiologies. These complications are complex in nature but most patients will respond to an individualized treatment plan that combines surgical and medical interventions.

UR - http://www.scopus.com/inward/record.url?scp=77953552638&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77953552638&partnerID=8YFLogxK

M3 - Article

C2 - 20583519

AN - SCOPUS:77953552638

VL - 76

SP - 622

EP - 625

JO - American Surgeon

JF - American Surgeon

SN - 0003-1348

IS - 6

ER -