Postoperative anal stenosis after procedure for prolapse and hemorrhoids (PPH): a literature review

Hemorrhoidal disease (HD) is among the most prevalent anorectal disorders, frequently necessitating surgical management in advanced stages. The Procedure for Prolapse and Hemorrhoids (PPH), also known as stapled hemorrhoidopexy (SH), has gained popularity due to its reduced postoperative pain and faster recovery compared with conventional hemorrhoidectomy (CH). However, postoperative anal stenosis (AS) remains one of its most serious long-term complications, substantially impairing patient quality of life. This literature review systematically examines the current understanding of postoperative anal stenosis following PPH, including its pathophysiology, incidence, clinical presentation, diagnostic criteria, management strategies, and preventive measures. The pathogenesis of AS after PPH is primarily attributed to tension-induced fibrosis resulting from circumferential stapling and the subsequent inflammatory cascade. The reported incidence varies widely (0.2–22%), reflecting technical variability and lack of standardization in studies. Risk factors encompass both patient-specific predispositions (e.g., hypertrophic scarring tendency, postoperative bowel irregularities) and technical errors such as low or deep purse-string placement and excessive tissue excision. Diagnosis relies on digital rectal examination and classification of stenosis severity. Treatment depends on disease grade: conservative management with dilatation suffices for mild cases, while moderate to severe stenosis necessitates surgical anoplasty, with the House advancement flap showing superior outcomes. Preventive strategies focus on precise purse-string placement 2–3 cm above the dentate line, maintaining submucosal suture depth, preserving mucosal bridges, and optimizing postoperative bowel management. Despite numerous advances, inconsistencies in reported incidence, lack of long-term prospective data, and unstandardized definitions of AS hinder comparative evaluation. Future research should prioritize standardized outcome measures, tension-reducing stapler designs, and rigorous long-term studies. Ultimately, prevention through meticulous technique and early intervention remains the cornerstone of managing this potentially avoidable complication.

Hali tarjima qilinmagan