Persistent pain and faecal urgency after stapled haemorrhoidectomy

Introduction Haemorrhoidectomy usually cures haemorrhoids. Day surgery is f easible, and is associated with high patients' satisfaction and few complic ations, but patients take an average of 2 weeks off work after surgery. Sta pled haemorrhoidectomy has the potential to decrease postoperative pain and time off work. However, data on longterm efficacy and function are lacking . Methods 22 patients underwent stapled haemorrhoidectomy: seven in a pilot s tudy, and 15 in a randomised controlled trial to compare the new stapled op eration with diathermy haemorrhoidectomy in a day-case setting. All operati ons were done by one consultant surgeon. Results 16 patients were followed up for longer than 6 months, five of whom (31% [95% CI 8.5-54.0%]) developed symptoms of pain and faecal urgency whi ch persisted for up to 15 months postoperatively. The randomised trial was suspended, and patients were investigated with endoanal ultrasonography, an orectal physiology, and examination under anaesthetic. All five affected pa tients were reviewed by two independent surgeons experienced in the stapled operation. In one patient, a fibroepithelial polyp was found adjacent to a n anodermal ulcer; in the other patients, no abnormality was found. Four of the five affected patients had some muscle incorporated into the doughnut, compared with only one of 11 of the unaffected patients (p=0.012, Fisher's exact test). No other significant differences in operative variables were identified between patients with and without symptoms, Interpretation Persistent severe pain and faecal urgency has been found in a disturbingly high proportion of patients after stapled haemorrhoidectomy. The mechanism behind this phenomenon is unclear, although muscle incorpora tion in the doughnut may have a role, Other groups who have studied stapled haemorrhoidectomy urgently need to audit their long-term results to assess the frequency of this problem.