circular stapler, probably interrupting the hemorrhoidal vessels and stretching the prolapsed mucosa [1]. The hemorrhoids are not dealt with because they are expected to become asymptomatic. Major complications of conventional hemorrhoidectomy are early or late hemorrhage, anal stenosis, and fissures.

In addition, other complications or complaints after hemorrhoidectomy have been reported such as pain, urinary retention, urinary tract infection, mucosal prolapsed, pseudopolypi, epidermal cyst, anal canal fistula, pruritis ani, fecal incontinence and recurrent hemorrhoids [2].

Complications reported for stapled hemorrhoidectomy are similar to those of open hemorrhoidectomy. In addition, other complications such as hemorrhoidal thrombosis, rectal anastomotic leakages with pelvic sepsis, rectal obstruction, retrorectal hematomas, and Fournier gangrene have been reported. The patients complained of the fissure, pain, hypertrophied anal papilla, proctalgia Fuga, and thrombosis [3-4].

The patients had a mean age of 51 years (range, 30-65 years). Most complications occurred after the surgeon had more than 25 case experiences. Of the immediate complications, severe pain was the most common complication, requiring extra analgesics, followed by bleeding, thrombosis, urinary retention anastomotic dehiscence, fissure, hemorrhage, and submucosal abscess (Table 1). The immediate complications were treated as followed: all patients complaining of pain had extra analgesics.

Materials and Methods

Setting - Study conducted at R. D. Gardi Medical College, Ujjain., MP, India

Study Duration - from November 2017 to November 2019.

Type of Study - It was prospective and retrograde

Sampling Methods- All the patients who were post-op (stapled hemorrhoidectomy) case of hemorrhoid disease, History, clinical examination along all baseline investigation done. Proctoscopy and Digital Per Rectal examination were the main diagnostic modalities used.

Sample Size- 400 post-op case of stapled hemorrhoidectomy

Inclusion Criteria- All the patients who were post-

submucosal abscess. All patients complaining of pain had analgesics.

Table-2: Late complications of stapled hemorrhoidectomy reported for 400

Complication	Patients (%)
None	91.5
Recurrent hemorrhoids	2.0
Severe pain	1.5
Stenosis	0.5
Fissure	0.5
Bleeding	1.0
Skin tag	0.5
Thrombosis	0.5
Papillary hypertrophy	0.5
Fecal urgency	0.5
Staples problems	0.5
Flatus incontinence	0.5
Fecal incontinence	<0.5
Mucosal septum	<0.5
Partial dehiscence	<0.5
Intramural abscess	<0.5
Intussusception	<0.5

The bleeding was treated surgically in 4 cases, by insertion of a Foley catheter in 2 cases, and by epinephrine infiltration in 2 cases, the remaining 8% needed no treatment while 2 needed a blood transfusion. Anastomatic dehiscence was due to a malfunctioning of the stapler in 4 cases and incomplete stapling in 1 case; The rectal hemorrhage resolved spontaneously and the submucosal abscess was drained. Recurrent hemorrhoids were the most common late complication of stapled hemorrhoidectomy, found in 2% of patients of all treated patients (Table 2). The late complications were treated as follows: recurrent hemorrhoids were treated by rubber band ligation in 4 of 400 cases. The remaining cases of hemorrhoids were not treated. Anal stenosis was treated by dilatation in 2 patients. The fissure is treated with diltan dilatation. The intramural abscess is drained and the patient with intussusception underwent rectopexy. All patients had favorable results after the second therapy.

Discussion

When the rectal mucosa enters the anal canal, at the pelvic floor, it is thrown into longitudinal folds, known as columns of Morgagni. These folds contain, in the underlining mucosa, the internal hemorrhoidal plexus which is made of sinusoids [5-6]. The hemorrhoidal sinusoids and the connective

because there was too much-folded mucosa in the stapled line. Taking larger bites of the mucosa into the purse-string increases space on which the staples are fired against, making the staples inefficient for hemostasis. Avoiding placing the purse-string at the inlet of the anal canal may help not taking pelvic floor muscle into the deep bites of the purse string.

Thrombosis was another complication of stapled hemorrhoidectomy, probably because the hemorrhoid sinusoids were not removed and therefore were easily traumatized during the procedure. Fissures may have occurred when too much-folded mucosa was included in the staple line. The larger mucosal fold can break and can give origin to a fissure that will not heal until the staples are removed completely and the fissure is spread out. When a patient complains again of hemorrhoidal symptoms after stapled hemorrhoidectomy, the symptoms should not be called recurrent. This is because the hemorrhoids are never actually removed. What is recurrent is that the patient still complains of the problem that brought him to the doctor in the first place. In this study, the patients who had recurrent symptoms were treated by rubber band ligation or by Milligan-Morgan hemorrhoidectomy [8].

Hemorrhoidectomies or other open and closed techniques have shown that the stapled procedure gives Less postoperative pain and faster return to normal activities is more expensive than conventional techniques and has a similar complication rate [9]. These randomized trials between stapled hemorrhoidectomy and conventional surgical hemorrhoidectomy are not appropriate, because they compare two different approaches to the hemorrhoidal problems. Stapled hemorrhoidectomy leaves the pathology and does not deal with external hemorrhoids or associated anal canal problems. Surgical hemorrhoidectomy excises the hemorrhoidal tissue and deals with internal-external hemorrhoids and associated pathology. In our opinion, a therapeutically approach similar to stapled hemorrhoidectomy is banding, in which the redundant hemorrhoid folds are strangulated by a ring the external hemorrhoids and associated pathologies are not treated. A randomized controlled trial comparing these two similar techniques has not been published [10-11].

Major complications reported after stapled hemorrhoidectomy (e.g. pelvic sepsis, bleeding, obstruction, and Fournier gangrene) were probably

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