Postoperative complications after the procedure for prolapsed and hemorrhoids (PPH) and stapled transanal rectal resection (STARR) procedures

The procedure for prolapse and hemorrhoids (PPH) and stapled transanal rectal resection for obstructed defecation (STARR) carry low postoperative pain but may be followed by unusual and severe postoperative complications. This review deals with the pathogenesis, prevention, and treatment of adverse events that may occasionally be life threatening. PPH and STARR carry the expected morbidity following anorectal surgery, such as bleeding, strictures, and fecal incontinence. Complications that are particular to these stapled procedures are rectovaginal fistula, chronic proctalgia, total rectal obliteration, rectal wall hematoma, and perforation with pelvic sepsis, often requiring a diverting stoma. A higher complication rate and worse results are expected after PPH for 4th-degree hemorrhoids. Enterocele and anismus are contraindications to PPH and STARR, and both operations should be used with caution in patients with weak sphincters. In conclusion, complications after PPH and STARR are not infrequent and may be difficult to manage. However, if performed in selected cases by skilled specialists aware of the risks and associated diseases, some complications may be prevented.