Department of General and Visceral Surgery, Asklepios Hospital Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany.
Tech Coloproctol. 2011 Sep;15(3):259-64. doi: 10.1007/s10151-011-0704-6. Epub 2011 Jun 22.
Various sequelae which might lead to reintervention have been described after stapled rectal mucosectomy for hemorrhoids. One potential treatment modality for persistent complaints after stapled hemorrhoidopexy (SHP) or stapling for rectocele is the so-called agraffectomy (removal of the retained staples). This treatment option means a further procedure that can range from removal of the staples through the anoscope to removal of the entire staple line with the associated scar tissue.
In order to review the published literature, we conducted a search on Medline, Pubmed, and Embase using different terms for "agraffectomy."
Overall, fourteen reports were found, dealing with agraffectomy for various conditions after low rectal stapling for hemorrhoids or rectocele. Agraffectomy is a rarely mentioned treatment option for conditions after SHP. In rectal stenosis with complete occlusion of the rectal lumen, the removal of the stenotic anastomosis and remaining staples seems to be reasonable. The same can be said of the removal of retained staples for rectal bleeding or in order to avoid penile injuries in anal intercourse. In contrast, the collected published reports on agraffectomy in this review only provide low-level evidence that this procedure provides relief for other problems such as incontinence or chronic pain.
There is no clear evidence that agraffectomy is indicated if not in case of rectal stenosis and hemorrhage caused by the staples.
吻合器痔切除术（RMM）后可能会出现各种导致再次干预的后遗症。吻合器直肠黏膜环切钉合术（SHP）或直肠前突吻合器修补术后持续性不适的一种潜在治疗方法是所谓的吻合钉切除（去除残留的吻合钉）。这种治疗选择意味着需要进行进一步的手术，范围从经肛门镜取出吻合钉到切除整个吻合钉线和相关的疤痕组织。
为了回顾已发表的文献，我们使用“吻合钉切除”的不同术语在 Medline、Pubmed 和 Embase 上进行了搜索。
总体而言，共发现了 14 篇报告，涉及各种低位直肠吻合器吻合术治疗痔或直肠前突后出现的吻合钉切除。吻合钉切除是 SHP 后出现各种情况的一种很少提及的治疗选择。在直肠狭窄且直肠腔完全闭塞的情况下，去除狭窄的吻合口和残留的吻合钉似乎是合理的。对于直肠出血或为了避免肛门性交时阴茎受伤而去除残留的吻合钉也是如此。相比之下，本综述中收集的关于吻合钉切除的已发表报告仅提供了低水平的证据，表明该手术可以缓解其他问题，如失禁或慢性疼痛。
如果不是由于吻合钉引起的直肠狭窄和出血，吻合钉切除并无明确指征。
