Complications of Hemorrhoid Surgery

Introduction to Stapled Hemorrhoidopexy

Stapled hemorrhoidopexy has a well-documented association with retroperitoneal sepsis and pelvic sepsis, complications that do not occur with other hemorrhoid surgery techniques, according to the American Society of Colon and Rectal Surgeons 1
The mechanism of stapled hemorrhoidopexy involves inadvertent excision of full-thickness rectal wall rather than mucosa and submucosa only, leading to rectal perforation and subsequent deep pelvic/retroperitoneal infection, as reported by the European Society of Coloproctology 1, 2

Photocoagulation is a minimally invasive office procedure using infrared or laser energy that causes superficial tissue coagulation, and does not involve deep tissue manipulation or create pathways for retroperitoneal infection, as stated by the World Journal of Emergency Surgery 3
Rubber band ligation is a superficial procedure that does not access deep pelvic spaces, and complications are limited to bleeding and thrombosed external hemorrhoids, according to the American Gastroenterological Association 3
Cryotherapy complications include pain, tissue necrosis, and incontinence, but not deep pelvic sepsis, as reported by the World Journal of Emergency Surgery 3
HAL-RAR has lower complications but higher recurrence, and there is no literature linking this procedure to retroperitoneal or pelvirectal abscess formation, as stated by the European Society of Coloproctology 3