A four-year retrospective study and review of selection criteria and post-operative complications of stapled haemorrhoidopexy.

BACKGROUND: Severe life-threatening complications have been reported from the use of procedure for prolapsed haemorrhoids (PPH). First, we assessed post-operative complication rates over 4 years of PPH experience. We then sought to assess the impact of selection criteria for patients receiving PPH on post-operative complication rates and review our findings in the context of published literature.

METHODS: Over a 4-year period 2006-2010 at Hinchingbrooke Hospital, all 118 patients receiving PPH were audited for readmissions with post-operative complications using the admission database. A further retrospective audit of 50 patients' notes assessed the impact of selection criteria for PPH on post-operative complication rates. All PPH operations were performed by one of two senior colorectal consultants using the standard technique with a circular stapler.

RESULTS: Of the 118 patients from the 4-year audit, 12 (10 %) patients were readmitted. Two (1.7 %) of these 12 patients had post-operative pain, six (5.1 %) had rectal bleeding, three (2.5 %) had urinary retention, and one (0.8 %) had localised infection. There was one (0.8 %) patient mortality resulting from severe sepsis from an infected intra-abdominal haemorrhagic collection. In the following audit of 50 patients' notes, 15 patients had internal prolapsed haemorrhoids alone, of which one (6.6 %) experienced post-operative complications compared with six (55 %) of the 11 patients who had haemorrhoids and skin tags.

CONCLUSIONS: With careful selection of patients, PPH may be indicated for prolapsed internal haemorrhoids. More specific national guidelines are required with regard to contraindications to PPH.