REVIEWS   

Chirurgia 2015 October;28(5):183-92

Copyright © 2015 EDIZIONI MINERVA MEDICA

language: English

Serious and life-threatening complications after procedure for prolapse and hemorrhoids: a review

Avgoustou C.

Second Surgical Department, General Hospital “Constantopoulion – Aghia Olga”, Nea Ionia, Athens, Greece

The procedure for prolapse and hemorrhoids (PPH) carries the expected morbidity following anorectal surgery, such as low postoperative pain and low rates of bleeding, stenosis and incontinence, as well as low reintervention rates. The apparently simple PPH really requires long training and possesses technical pitfalls. Although uncommon, serious and devastating complications, such as perineal or pelvic sepsis, rectal perforation, peritonitis, rectal obliteration, intraabdominal bleeding and rectovaginal fistula have been described. This review article evaluates in detail each of those aspects concerning the major complications after PPH from a clinicians perspective and how can they prevented. A review of the literature from 1998 to date was performed regarding life-threatening complications after PPH. Life-threatening complications after PPH are rare and they are all attributed to surgical errors and to including non-candidates for the procedure. Misapplication of the purse-string suture in height and depth in the circumferential rectal wall and whole-thickness stapling are the main contributing factors of major complications. Physical findings and warning clinical signs should alert surgeons about the occurrence of such complications. Once occurred, timely aggressive medical and surgical treatment, mostly including antibiotics, laparotomy for fecal diversion and perineal debridement should halt the progression of sepsis in most cases. Major complications after PPH, described as isolated cases but being potentially fatal, mainly attributed to technical errors, might suggest that the operation should be performed by experienced surgeons who are familiar with the technique and aware of possible complications.