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Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line

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Abstract

Background

Persistent anal pain (PAP) after stapled procedures, be it hemorrhoidopexy (PPH) or stapled transanal rectal resection (STARR) may be hardly resolved by medical therapy. The typical objective finding in these patients is the staple line characterized by fixed scar to underlying layers.

Methods

A total of 21 consecutive patients were operated for PAP after stapled procedure. The scarred staple line was excised and detached from layers below, the mucosal continuity reconstructed by single stitches. From January 2003 to December 2013 1500 patients underwent stapled procedure. Of these patients treated in our unit, 9 (0.6 %) were operated for chronic anal pain and 12 were referred to our center from other hospitals.

Results

Fifteen (71.4 %) patients resolved and do not take any drugs for pain; an overall of 85.7 % (18/21) improved their clinical status. Mean time between the beginning of symptoms and the operation was 4.27 months (range 1–18 months). We divided the patients into three groups: before 3 months, between 3 and 6 months and after 6 months from the beginning of symptoms to the operation. The best results were in the first group with 100 % pain relief and satisfactory functional results.

Conclusions

The relief of PAP after stapled procedure, in which we recognize a scarred and fixed staple line, depends by the early recognition of this typical finding. The authors suggest the surgical treatment not later than 3–6 months after the onset of symptoms to achieve the best results.

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Authors and Affiliations

  1. Proctological and perineal Surgical Unit, Department of Gastroenterology, Cisanello University Hospital, Pisa, Italy

    Claudia Menconi, Bernardina Fabiani, Iacopo Giani, Gianluca Toniolo & Gabriele Naldini

  2. General, Emergency and Mininvasive Surgery I, Careggi University Hospital, largo Brambilla 3, 50134, Firenze, Italy

    Jacopo Martellucci

Authors
  1. Claudia Menconi
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  2. Bernardina Fabiani
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  3. Iacopo Giani
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  4. Jacopo Martellucci
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  5. Gianluca Toniolo
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  6. Gabriele Naldini
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Corresponding author

Correspondence to Jacopo Martellucci.

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Menconi, C., Fabiani, B., Giani, I. et al. Persistent anal and pelvic floor pain after PPH and STARR: surgical management of the fixed scar staple line. Int J Colorectal Dis 31, 41–44 (2016). https://doi.org/10.1007/s00384-015-2355-y

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  • DOI: https://doi.org/10.1007/s00384-015-2355-y

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